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www.cirmagazine.com OCCUPATIONAL HEALTH CIR March 2005 39 matter is obviously one for review. With the help of a detailed report on all factors relating to the patient’s ability to return to work – this could not only be on their physical function, but on their family/social circumstances, ability to drive to and from work, attitude to their employer and an outline of the specified job with that employer following a work site assessment – an OH physician or case manager may assist in a GP in reaching a more informed decision. There is a clear argument here for a more active role among OH physicians to assist and educate GPs in getting employees back to work, and is perhaps a way for the UK to begin to improve its rate of return to the workforce of its sick and injured – a rate which currently stands at 14 per cent. An age old problem? As Tim Ablett, chief executive of First Assist Group, succinctly puts it: “We are living longer but we’re fatter and uglier”. The UK’s ageing workforce has enormous implications for the well- being of both individuals and organisations. Jo Jenkins, occupational health lead at Campbell’s, points to research that shows that by 2008, the number of people aged 45 and upwards in the workforce will increase from 33 per cent to 44 per cent. The current pensions crisis also means that more people hoping to retire at 65 or earlier will have to stay in employment, and by December 2006 the EU directive outlawing age discrimination will come into force. OH professionals will need to fully embrace a huge array of medical conditions associated with age such as degenerative musculo-skeletal disorders, eyesight deterioration, cardiovascular disease, malignant disease and diabetes. An awareness of an individual’s decline in mental ability to process information, particularly, in the more skilled work areas, also needs to be considered. Shift working and the ability to do night work significantly decrease. The challenges facing modern OH services, will be, as Jo Jenkins points out, to adapt services to offer well- being clinics with extended specialist services such as chiropody and disability provision. The news is not all bad, however. Unlike its younger colleagues, research shows that the ageing workforce is more dependable, less prone to absenteeism and brings a wealth of experience to an organisation. The factors which make advancing age a handicap are mostly concerned with the constraints in working conditions and types of work organisation. As the European Foundation for the Improvement of Living and Working Conditions states: “Age-friendly job design should include: adapting the workplace, premises, equipment, working hours and processes to the employee’s changed capacities; taking the changed capacities of older workers into consideration by selective organisation of training opportunities…” All in a day’s work For employers seeking to manage these risks, early intervention (from day one of an absence or injury) is important. Accurate sickness and absence management and bespoke OH provision which is specific to an organisation’s risks is proving a successful model in reducing absence rates. Larger organisations are ahead in this field – greater awareness and training to SMEs needs to take place for the effect to be consistent. Case management to supplement all these services and to implement, co-ordinate and monitor rehabilitation programmes is another means to assist employers in returning sick and injured employees back to work. Whether this is provided independently or under the employer’s liability insurance policy, the overall aim is for the case manager to co- ordinate the medical and vocational interventions and to ensure a public and private sector partnership occurs to restore an individual and the organisation to maximum health and well-being. Rosie Corless, BSc RGN DN, is rehabilitation manager at QBE Insurance, and director and chair of CMSUK QBE endorses case management and by utilising the skills of their in-house rehabilitation experts, are assisting many organisations to return injured employees back to the workplace in a cost effective way. As founder members of CMSUK, QBE Insurance have supported this new organisation in its innovative work – the recent publication of the CMSUK Standards of Best Practice is recognised as breakthrough in their work to establish case management as a profession in its own right. www.cirmagazine.com OCCUPATIONAL HEALTH CIR March 2005 38 n ageing working population, rapidly advancing technological innovations with associated new risks and overload, globalisation and the downsizing of organisations are just the tip of the iceberg of challenges facing UK organisations today in all sectors and across all industries – not to mention a poor return to work history and not least the questions surrounding GPs issuing sick notes. Successful organisations evolve with their surroundings and organisations that choose to recognise the importance of a biopsychosocial approach to the health and well-being of their employees as opposed to just the biomedical model will have a far better chance of survival in a working and living environment that is rapidly evolving and changing. Understanding the importance of work in relation to an employee’s mental, physical and social well- being is central to the role of a modern occupational health (OH) service and physician. By ensuring innovative practice, challenging the culture and perception of illness and disease and moving away from the focus of absenteeism towards presenteeism, disability to residual capacity, and utilising case management, the significant value of the OH role will be revealed. The recommendation to a GP for an employee to return to the workplace as soon as possible in order to prevent disability beliefs from arising was noted as one of the key roles of the modern OH physician at last month’s QBE Annual Employers Liability Conference. The bottom line Understanding how OH can directly impact on an organisations’ bottom line is one starting point towards understanding how to manage that organisation’s overall risk exposure. Gaining an understanding of the ‘well-being landscape’ of the organisation can reveal the nature and extent of employee well-being and appropriate well-being services put in place to address to reflect this landscape. Dr Les Smith, medical director, Premier Occupational Health, advises a thorough assessment of the parts of a business which reveal high accident and inactivity rates and stress related absences with clear indicators as to the percentage related to work. This, he says, is where occupational health can subsequently energise individuals, encouraging them to achieve a good work/lifestyle balance towards realistic goals in health – described uniquely as “a used pair of trainers, an empty medicine cabinet and not knowing the name of your GP”. Considered as one of the fundamental roles of a modern OH department is the assessment of musculo-skeletal problems and the impact of a work accident on an employee. By basing a return to work programme on objective information, assessing capability and having specific fitness for work criteria (as opposed to the use of ‘light duties’ crtieria, for example), practitioners can expect to see greater success in return to work programmes. Through her work as group occupational health adviser at PSA Peugeot Citroën, Dr Barbara Kneale has implemented a functional muscle evaluation tool into the workplace which allows accurate, objective and understandable baseline measurements of an employees functional capacity. The tool enables her organisation to match these capabilities to specific jobs and highlight areas for treatment to monitor the progress of an employee against a particular timeframe. In addition to the obvious benefits, motivation during a long and complex rehabilitation programme can be maintained through the use of objective data on muscle strength and production of progress charts. Its value in pre-employment screening to secure a suitable and safe placement for an employee is a further key feature and an obvious one in helping reduce risk. Such objective measurements can help OH professionals to better communicate with GPs on a patient’s ability to return to employment. The GP medical certification scheme is a current issue on the Government’s agenda and debates are occurring on whether employers should take on the responsibility for sick notes. And with GPs themselves claiming that 20 per cent of all medical certificates are invalid, and that they receive minimal training on return to work issues, the Rosie Corless examines the changed value of modern occupational health, and describes how employers can implement innovative and appropriate policies to ensure a productive and healthy workforce Workology A
