A Occupational Health Unit Annual Report 2010 / 2011 Statistical Update A Paper submitted to the Health and Safety Committee Meeting, on 5 th April 2012, by Janet Craig. Introduction This report is an indication of occupational health activity within the University over academic year 2010/2011 and should be considered in conjunction with the Occupational Health Unit Annual Report 2010/11 Interim Summary, presented to the University Health and Safety Committee in April 2012. We have categorised our main activities into 3 broad areas as indicated. This chart is a broad overview of contacts or episodes which we record in the Occupational Health Unit (OHU) and includes all categories of initial contact. This does not reflect the time allocated to each contact for example health surveillance tends to be quite a quick contact when compared with a referral contact therefore referrals are increasingly taking more of the working time within the unit. Broad Activity Overview of OHU 2010/2011 39% 44% Statutory Health Surveillance Immunisations /Travel 17% Referrals The following pages will explore these categories in more detail. Page 1
Referrals Referrals divided into area and including Manager and Self referrals Manager and Self Referrals by Area 300 No. of Referrals 250 200 150 100 50 0 Support HSS MVM Sc&E Services Self Referrals 46 23 18 30 Manager Referrals 218 47 40 72 We have for the purpose of this report put both manager and self-referrals by area together for comparison purposes and to reflect that the majority of referrals remain those done by management or Human Resources. Comparison is now possible with previous annual figures, and as noted previously there continues to be a varied approach to management of absence across the Colleges and Corporate areas. Manager & Self Referrals 2009/10 and 2010/11 250 No. of referrals 200 150 100 Manager Referral Self Referral 50 0 SS 09/10 SS 10/11 HSS 09/10 HSS 10/11 Area MVM 09/10 MVM 10/11 Sc&E 09/10 Sc&E 10/11 Page 2
Referrals (cont.) Within Corporate Support Service areas the use of OHU in absence management has increased, however in the other areas there has been a small decrease in referral rate. OHU have been working closely with HR particularly in Corporate Support Groups, with both case management and participation in manager training in order to improve absence management and OHU involvement in support for this area. We continue to encourage a similar approach to training for managers in the areas where there has been a decrease in referral rate and would be hopeful that a continued profile increase in these areas may impact on referral rates, as will increase in OH and HR partnership working. As noted previously, this should include defining the operational and working processes and procedures to be followed when working with OH, and we hope that this will impact on the quality of service provision for health advice as discussed in the previous report. One further rationale for decrease in figures may be that GP fit notes guiding return to work could be impacting on local management of return to work, although a key element in managing absence effectively is accurate measurement and monitoring of length and frequency of absence and we do not have this information. Reasons for Referral In broad categories the reasons for referral reflect those of national averages for the UK, dependant on type of work; 35% Health Reasons for OH Input 30% 25% 20% 15% 10% 5% 0% MSD Mental Health Medical Surgery Percentage of referrals 32% 31% 25% 12% Page 3
Reasons for Referral (cont.) We have four broad categories which demonstrate that the organisation tends to follow the same reasons for absence as national averages. These are categorised by Unit staff following consultation and include MSD which refers to musculoskeletal disorders, Mental Health refers to all non-physical issues such as anxiety depression et al, Medical are broadly those conditions that would be considered as treatable on medical wards of hospitals ie strokes, multiple sclerosis et al, and Surgical are all absences referred as a result of surgical intervention. For comparison there is a table below produced by the Chartered Institute of Personnel and Development (CIPD) in May 2012 outlining the main causes of sickness absence for manual and non-manual employees have been identified as: Manual Non-Manual Minor illness (includes colds, flu, stomach upsets and headaches) Minor illness (includes colds, flu, stomach upsets and headaches) Musculoskeletal injuries Stress Back pain Musculoskeletal injuries Stress Back pain Home/family responsibilities Home/family responsibilities Recurring medical conditions Recurring medical conditions Mental ill health (for example clinical depression and anxiety) Mental ill health (for example clinical depression and anxiety) Our intention is to build these figures up for further future comparisons. Page 4
Health Surveillance Health Surveillance Breakdown Parking Permit Asses Radiation (CERN) Radiation (IR) Asbestos Vision Screen (VDU) Category Vision Screen (MB) Spirometry Skin Audiometry Night Workers 0 50 100 150 200 No. of episodes General Lab Workers (S) General Lab Workers (I) Animal/Lab (S) This graph reflects the total numbers of both baseline and follow-up health surveillance and the types of surveillance carried out in the OHU and off-site clinics. The graph shows the largest category of staff seen in OHU for health surveillance is because of laboratory work with animals, this includes contact with OHU for lung function measurement or Spirometry. It is worth pointing out that General Lab Workers surveillance totals also include Spirometry testing as do some others, however, for OHU purposes we have made these separate categories to allow OHU to make distinction between the types of exposure i.e. exposure to rodents or other sensitiser, or serial or initial surveillance. OHU hope this information may be useful in future in order for us to monitor future compliance, identify areas of potential allergy development and general areas of concern. We have previously raised concern that some persons may be being exposed to laboratory animal allergens for significant periods without adherence to recommendations, compliance with utilising PPE and or establishing baseline health surveillance, and this remains a concern. Work continues to improve compliance with health surveillance requirements. To this end, health surveillance clinics across the organisation continue to increase. The responsibility to assess the risks to individual s lies with local managers to ensure compliance with COSHH as does the attendance for screening by those employees identified by risk assessment. Page 5
Immunisations and Travel The OHU statistics for Immunisation and travel, shown on the graph on page 1 accounts for 17% of our activity and these are given to individuals where immunity or protection is required due to any potential risk of exposure at work. This includes a wide ranging client base working with a specific potential hazard exposure and/or for work related to travel. As noted in our previous report early access to the OHU for immunisations preferably prior to exposure is extremely important. We have increased our range of available vaccinations now including yellow fever and can provide full travel guidance. We are actively involved in increasing knowledge relating to travel risk and provision of travel advice service provision across the organisation. Janet Craig September 2012 Page 6
Appendix Occupational Health Unit Annual Report 2010 / 2011 Interim Summary A copy of the report (Paper D) which was previously submitted to the Health and Safety Committee Meeting, on 5 th April 2012, by Janet Craig. Introduction This report is an indication of activity over academic year 2010/2011, a fuller report including statistics will be provided at the next meeting. Health surveillance, immunisation programmes and absence management remain the core elements of the work of the Occupational Health Unit (OHU). Broad Activity Overview of OHU activity 2010/2011 505 568 Statutory Health Surveillance Parking Permit Immunisations/Travel Referrals 219 23 1
Health Surveillance Work continues to improve compliance with health surveillance requirements and health surveillance coverage continues to increase. The merger of the Medical Research Council Human Genetics Unit (MRC- HGU) at the Little France and Western General Hospital (WGH) sites has contributed to an increase in numbers of staff requiring health surveillance, and compliance with attendance is also greater. Since the merger with Edinburgh College of Art (ECA) there has also been increased identification of need for health surveillance from this area. This is the third year in a row that OHU have managed to increase the uptake of health surveillance, which is contributing to the organisation s compliance with health and safety requirements. The responsibility to assess the risks to individuals to ensure compliance with the Control of Substances Hazardous to Health Regulations, and to ensure attendance for screening by those employees identified by risk assessment, lies with local managers. The OHU continues to work more closely with managers to seek ways of improving the exchange of information on health surveillance and to inform people of the statutory nature and purpose of health surveillance. In areas where an identified person (e.g. line manager, local safety adviser/manager) is involved in strong liaison with the OHU, health surveillance coverage appears to be best. Whilst most baseline and some follow-up health surveillance appointments continue to be carried out in the OHU, on-site surveillance continues to increase from one day per month in 2009/2010 to two days per month currently. This level is expected to continue. Individuals are advised during face fit testing for respiratory protective equipment (RPE) that they should consider attendance for health surveillance. Despite increased numbers attending for screening we have concerns that in some areas where persons are exposed to laboratory animal allergens, they are permitted to have significant periods (e.g. months) of exposure to allergens prior to baseline health surveillance. This area of concern requires some further consideration by managers in these areas. 2
Health Surveillance (cont.) The OHU has received the transfer of medical records from NHS Lothian for MRC HGU including non-employees or those that had left prior to merger, in order to ensure more than baseline recording of health surveillance for these employees. This took up a large amount of OHU s time to filter out the current employees, and ensure that these employees now have health surveillance records and are on the OHU s health surveillance recall system. The records relating to non-university employees were returned to NHS Lothian. OHU continue to receive Night Workers health questionnaires. No individual took up the opportunity to have an appointment with Occupational Health as offered in the questionnaire. Immunisations The OHU continues to provide immunisations for those working with specific potential hazard exposures and/or for work related travel. As noted previously, early access to the OHU for immunisations prior to exposure is extremely important. The OHU has increased the range of vaccinations available with the exception of yellow fever, provide full travel health guidance and are actively involved in increasing this service across the organisation. Occupational Diseases As noted previously there is now less emphasis on the reporting of cases of suspected occupational ill health received using the formal paper reporting system. Instead there is a system within the Occupational Health Unit for combining formal reports with management referral and self-referral data, to provide a clearer picture of occupational ill health experience within the University. 3
Occupational Diseases (cont.) There were 2 cases of Occupational Disease, Reportable to the Health and Safety Executive. 1. A member of technical staff was assisting a Vet who was taking research blood samples from cattle and sheep at 2 University farms, wearing appropriate protective clothing. The employee later attended a GP where cryptosporidiosis was subsequently diagnosed. The employee was admitted to hospital for treatment. The employees condition was complicated by a pre-existing medical condition. This case was drawn to the attention of Lothian Health Public Health Team. A comprehensive review of hygiene and hand-washing arrangements was implemented at the University s farms following a previous outbreak of cryptosporidiosis within our student population. Following investigations these procedures were further tightened for staff visiting the farm sites. 2. A member of technical staff working in a supervisory role within a biological research facility was diagnosed as being in the early stages of developing occupational asthma. The employee was excluded from work whilst further medical information was obtained. A review of work procedures within the facility was carried out and staff have been reminded of the importance of occupational health surveillance and effective use of respiratory protective equipment (RPE). In addition, there was one other notable ill health occurrence; 1. A PhD student self-referred to OHU with symptoms of asthma. Following investigation and further health surveillance a diagnosis of early stage occupational asthma was made. The workplace concerned has been advised and the individual has also been advised to minimise any further exposure. This occurrence appears to have arisen as there was sharing of RPE rather than being face fitted for the appropriate mask and no health surveillance provision had been sought. 4
HR/OH partnership working Representatives from the University Human Resources (HR) and Occupational Health (OH) teams across the organisation were tasked some while ago with defining the operational and working processes and procedures to be followed when working with OH, to ensure consistency of process and also to ensure expectations of the services provided were clear. Following a series of meetings, this group developed a document which clarifies the context in which advice and guidance is given by the OH professional staff to the organisation and its representatives. The resultant document is intended as a memorandum of understanding to assist all parties when working in partnership with the OH service and outlines extensive important professional and legal constraints which the OH professional staff are obliged to follow. This has been disseminated across the HR community and it is hoped that this will encourage further HR and OHU partnership and improve on the quality of service provision for health advice. Employee and manager contacts through referral (manager/self) There continues to be a varied approach to absence management across the Colleges and Corporate areas although there appears to be greater adherence to policy since the introduction of the absence management and capability policies. OHU have been working closely with HR particularly in Support Groups and the College of Science and Engineering (S&E), with both case management and participation in manager training. Where this has occurred case management for absence or health issues that impact on work has much improved; cases close more quickly, are less complicated and staff are returning to work and therefore contributing. This has improved on OHU time management and availability and, predictably, absence within these areas. 5
Employee and manager contacts through referral (manager/self) (cont.) OHU are actively working to encourage a similar approach in the Colleges of Medicine and Veterinary Medicine (MVM) and Humanities and Social Science (HSS) as individuals can be significantly far into an illness or absence period before referral occurs. These tend to be HR-led referrals when compared to other areas of the organisation. To some extent in the medical professional areas of MVM it may be that OHU advice is less relevant. However amongst the non-medical staff, lack of referral implies continuing evidence of a need for management training as evidence suggests early OH intervention is more successful in securing return to work. In HSS, HR referral can take place much further into the absence period including on one occasion two years after initial absence. Absence of such length is costly to the individual and to the organisation in terms of financial impact and time. In terms of case management these cases are usually a negative client experience and are unlikely to result in return to work. We therefore continue to encourage early intervention and that advice be sought for the benefit of the individuals and the employer. Other contacts The OHU continues to play an active role in the assessment of employee parking permit applications where there are health implications, working in close liaison with the Parking Office. The OHU continues to work closely with the Pensions Office and HR on improvement in the process for applications for early retirement on medical grounds (ill health retiral), which vary depending on the different pension scheme. This has implications for the University for those staff whose applications fail and are assessed as suitable for some type of work by the pension s trustees and input from HR is required in assisting staff and managers in this area. 6
OHU Activity / raising profile The OHU have arranged a number of meetings and sessions to outline the service, effective referral and to continue to raise the profile. We had direct contact with ECA staff in December via the School Administrator to further raise awareness of OHU, counselling and support services available to assist through change management. The OHU participated in a short workshop to explore effective ways of promoting the University's Social Responsibility and Sustainability [SRS] strategy. An OHU representative has attended the Roslin Institute health and safety committee, to provide guidance and advice on health surveillance issues. The OHU continues to contribute to a number of training courses including absence management, mental health awareness, welcome day, animal licensee course and external presentations to discuss the OHU contribution to health and well-being in the workplace. We presented with Joe Brannigan "Safety management since 1802 and Occupational Health now" for Estates and Buildings. OHU have contributed to an initiative in the School of Biomedical Sciences, the Mental Health mentor training, and were invited to talk to the participants on the mental health and dignity at work training courses, arranged by Ann Diment, School of Biomedical Sciences. The OHU provides significant input to various health promotion initiatives within the University and extending to external groups. We have hosted a meeting of networked OH group across Scottish universities and have hosted a meeting for a user group who use the specialist occupational health computer based management system OPAS. General notable points A project in liaison with Information Services and Human Resources to streamline the download of HR information on new starters and leavers has been implemented with significant advantages to the OHU in terms of time and resources. The OHU has increased the use of functions within the medical records database (OPAS) which has streamlined procedures within the Unit, and allows more efficient record keeping. 7
General notable points (cont.) This includes the scanning of some medical information including archive notes onto the OPAS system, bringing relevant information together. The OHU plans to further increase the functionality of OPAS with the use of electronic questionnaires and more detailed analysis of information. The OHU plans to seek accreditation via the Safe Effective Quality Occupational Health Service (SEQOHS) voluntary accreditation system. SEQOHS involves a set of standards that aim to help to raise the overall standard of care provided by occupational health services. This process has been delayed due to staffing levels but will be progressed once staffing levels have stabilised. Janet Craig, April 2012 8