individuals, to avoid confusing their testing and occupational health roles Disciplinary action following substance misuse testing should not involve OH staff: this wo uld compromise employee relationships. Roles and competencies \200 Managers are responsible for the implementation of the policy \200 Medical Review Of \201 cer (MRO) is a physician with specialist knowledge and training in specimen collection, chain of custody, analytical procedures, and alternati ve explanations for positive analytical results OH practitioners may advise on policy and test arrangements. They have a separate role in a dvising employers and managers in support and rehabilitation arrangements and assessing \201 tness for work. 19_Smedley_Chap19.indd 379 1/2/2013 12:30:29 PM CHAPTER 19 Policies 380 Treatment and rehabilitation Workers who volunteer a substance misuse problem may receive a dvice and support to seek treatment and rehabilitation. Subject to their co-operation, many organizations will maintain their employment. Further information Faculty of Occupational Medicine (2006). Guidance on Alcohol and Drug M isuse in the Workplace . FOM, London 19_Smedley_Chap19.indd 380 1/2/2013 12:30:29 PM This page intentionally left blank CHAPTER 19 Policies 382 Travel policies 1: general travel policy Employees who travel on company business should be assessed, screened, prepared, and cared for during and after their trip. Most business tri ps will be low risk, but the following factors i risk. \200 Travel to remote or underdeve loped areas \200 Poor local infrastructure \200 Restricted access to medical facilities \200 Extreme climatic conditions \200 Transportation challenges \200 Individual \200 \231s behaviors. Travel policy Implementing a corporate travel policy can mitigate risk. Such a policy shoul d include the following headings: Risk assessment Risk assessment should include work activity; location; security situation; health care facilities; disease prevalence. Insurance \200 Comprehensive cover, appropriate to the individual and destination(s) \200 Include insurance for emergency medical evacuation for remote areas \200 Use insure rs that provide remote access to health resource information, and identify and source medical assistance if required. Security \200 2 Awareness and understanding of local security issues are vital \200 Inc lude 24-h contact for emergency advice \200 Give advice on personal behaviors that affect individual \200\231s risk \200 2 Road traf \201 c accidents are a common cause of morbi dity and mortality due to poor vehicle maintenance; driving skills; and roads. Immunizations: dependent on risk assessment \200 Carefully de \201 ne locations of count ry/region to be visited as there can be large differences between urban and rural disease v ectors and risks Refer to regularly updated travel advice, on-line if possible (e.g. MASTA, Travax). Ascerta in accurate immunization history Maintain documented mandated immunizations (e.g. yellow fever), to avoid entry denial or non-sterile local vaccination at borders. Psychological stressors Stressors include: \200 Complex and long travel itineraries \200 High expectations by the business \200 Jet lag \200 Cultural dysphoria \200 Family separation. Recognize the challenges and legitimize mitigating behaviors: \200 Encourage adequate rest before meetings \200 Consider Employee Assistance Program for this high-ris k group. 19_Smedley_Chap19.indd 382 1/2/2013 12:30:29 PM TRAVEL POLICIES 1: GENERAL TRAVEL POLICY 383 Personal guidance \200 Ensure traveler is aware of potential health challenges that may b e encountered Con \201 rm traveler understands strategies to preserve health during trip \200 Highligh t potential i risk behaviors during travel for business traveler \200 Pay particular atte ntion to alcohol, drug use, and sexual behaviors \200 Give traveler resume of essential h ealth tips as a simple guide. Health screening \200 Organizations may advise formal medic al evaluation +/ \200\223 additional tests (e.g. ECG, CXR) for frequent business travelers \200 Quantify the potent ial impact of pre-existing health issues that may deteriorate during travel De \201 ne medication carried (also cold storage for drugs e.g. insulin) \200 Consider t he availability of health resources at the destination. Malaria and insect borne diseases \200 Malaria is a signi \201 cant risk factor for travelers to endemic areas \200 Chemo prophylaxis starts before trip to assess compliance issues \200 Promote ABCD: Awareness; Bite prevention; Chemoprophylaxis; Diagnosis and treatment. 2 Travelers perceive malaria risk as small and may not follow advice. Circadian desynchrony (jet lag) ( b p. 144, Time zone changes) \200 Starts to have an effect after three time zones \200 Resulting fatigue affects concentration and decision-making \200 Allow time to acclimatize on arrival at destination in travel plans. Travelers \200\231 deep vein thro mbosis (DVT) \200 Probably an effect of travel for >5h \200 Risk factors include smokin g, recent surgery (10 days), pregnancy, family history of DVT, malignancy, medication (oral contraceptive pill (OCP), hormone repla cement therapy (HRT)). Advice on maintaining mobility and exercising during travel \200 Discourage tranquilizing medication \200\224may d mobility during \202 ights \200 Encourage adequate hydration +/ \200\223 compression stockings for journey. Traveler \200\231s diarrhea The most common traveler \200\231s health problem. Avoid/mitigate by advice; (cid:5) Eating freshly cooked food (cid:5) Eating fruit that can be washed or peeled (cid:5) Drink safe potable water/ice ; use boiled or reputable bottled water \200 Consider self-treatment antibiotics (cipro \202 oxacin etc.) in travel kit. Travel medical kits \200 Content varies in relation to d estination \200\224from simple over-the-counter painkillers, insect repellents, and skin dressings to more comprehensive k its with stand-by antibiotics, anti-diarrhoeals, and malaria prophylaxis Instructions should be clear and comprehensive. 19_Smedley_Chap19.indd 383 1/2/2013 12:30:30 PM CHAPTER 19 Policies 384 Post-trip precautions \200 Early reporting of post-travel fever or illness \200 2 Need to complete the full course of malaria prophylaxis, if prescribed EAP to be available for problems related to the stressors of travel. Further information MASTA. Available at: M http://www.masta.org/ Travax. Available at: M ht tp://www.travax.scot.nhs.uk/ CDC. Travelers health . Available at: M http://www.cdc.gov/tra vel/ 19_Smedley_Chap19.indd 384 1/2/2013 12:30:30 PM This page intentionally left blank CHAPTER 19 Policies 386 Travel policies 2: expatriate policy De \201 nition of the expatriate worker An employee w ho resides in another country for occupational purposes, but returns to their original coun try upon completion of the assignment. Expatriate policies Policies should include general travel advice ( b p. 382, Travel policy 1: general travel policies). However, prolonged residence requires extra considerations. T herefore, expatriate worker policies should also include the following sections. Selection process \200 Avoid pressing workers to accept postings i.e. for career progress ion \200 Encourage spouse to be involved in decision-making, as family problems are a com mon reason for expatriate posting failure. Pre-posting orientation Family orientation visits are helpful before acceptance of posting. The employee and their family should consider lifestyle factors that will be affected by t he move, including environmental, cultural and social changes, medical care, family adjustm ents, security, and schooling. Fitness for duty \200 Fitness for duty assessments should contain the following elements: evaluation of current diagnosed medical conditions \200 evaluation of psychological suita bility for overseas posting \200 physical capacity \200\223 if duties include physical \201 tness requirements. \200 All family members should be examined at regular intervals , especially for locations with potential high risk health exposures. Health resources at location \200 Detailed evaluation of local and regional health care r esources \200 Include national, private, and if available, in-house health facilities \200 Guidance on identi \201 ed limitations of available health care \200 De \201 ne h ow to assist expatriates identify/access routine health care \200 Avoid single providers wherever possible as options allow choice. Emergencies and medical evacuations (medivacs) \200 De \201 ne emergency procedures to deal with illness or injury that may exceed the scope of local health care resources Include all management that need to authorize release of corporate resources or \201 nanc e for management of the severely ill or injured. \200 Identify in-country \200\230liaiso n physician \200\231 to assess and communicate the patient \200\231s condition to local management and/or corporate medical staff \200 Under stand evacuation alternatives and time delays for each option. In high-risk postings, consi der a contract with air ambulance providers. Medication supply \200 Understand potential limitations in supply of prescribed drugs \200 Encourage routine prescription- \201 lling during scheduled home leaves \200 Advis e holding a minimum of 3mths supply of medication 19_Smedley_Chap19.indd 386 1/2/2013 12:30:30 PM TRAVEL POLICIES 2: EXPATRIATE POLICY 387 Where appropriate, communicate concerns related to counterfeit medicine supply in destination country or region Identify providers that will \201 ll and ship personal prescriptions overseas. \200 Som e countries may require a formal doctor \200\231s prescription when carrying certain medications. Medical insurance \200 Insurance should cover expatriate to provide, as far as practicabl e, equivalent level of care to that in home country Include medical evacuation insurance where appropriate \200 Ensure that excluded conditio ns are explicit, so that expatriates can mitigate potential gaps in care whilst on home leave Communicate processes for use of medical insurance and policy on reimbursement of any excess payments. Other issues Employee assistance program (EAP) 2 Expatriates are at high risk for psycholog ical dif \201 culties; EAPs offer a valu- able resource \200 Local EAP provider is prefe rable \200\224home country resource as a default \200 High-risk cases need \200\230red \202 ag \200\231 to corporate OH department for follow-up. Rotational assignments \200 Complicated risk group because of swinging cultural exposures \200 Often very extensive travel involved \200 On-site behaviors may be negatively aff ected by poor perception of risk, including unrealistic beliefs about ready accessibility to home country health car e. Post-assignment \200 Recognize the reverse culture shock of return to home country \200 Consider medical screening (e.g. for tropical disease) in employees and families returning from high-risk postings Reiterate availability of the EAP service to returning expatriates. In-patriates Expatriate s from another country who are on a temporary business related posting to the host country corporate of \201 ce location: \200 Need to understand scope of/access to, local health care provision \200 Need to be appraised of cultural issues \200 Recognize potential of employee importing illness not normally seen in host population, leading to dif \201 cult y/delay in diagnosis (e.g. malaria) EAP provision is essential for this high-risk group and families. 19_Smedley_Chap19.indd 387 1/2/2013 12:30:30 PM CHAPTER 19 Policies 388 Violence management policies Purpose To assist the organization in protecting its staff fro m abuse, threats or violence. (See also b p. 136, Violence and aggression.) Policy document s should cover the following: Arrangements for risk assessment and control \200 Management responsibility for assessing the risk of violence in every workplace and for each job or group of jobs Examples of good practice in risk reduction can usefully be given in an appendix (see Table 19.3). Promoting a culture where abuse is not permitted Give a clear message that aggression towar ds staff is not appropriate, and offenders will be prosecuted i.e. a \200\230zero toleranc e \200\231 approach. Training for employees All staff should be given basic information about violence and instr uctions for managing dif \201 cult behavior including how to raise the alarm: \200 Under stand the mindset of the hostile or potentially violent person \200 There may be a need t o \200\230communicate \200\231 their grievance to someone \200 Provide the hostile perso n with a verbal outlet \200 Use \200\230active listening \200\231 \200 Avoid confronta tion \200 Build trust with the hostile individual and provide help if needed \200 Allow a total airing of the grievance without comment or judgment \200 Preserve the individual \200\231s dignity, as fear of embarrassment will prevent hostile individuals from abandoning plans for violence Allow hostile people to suggest solutions for a win \200\223win resolution. Staff who are w orking in high-risk areas should have detailed training, including predicting and avoiding anger and aggression, defusion tech- niques, and using control and restraint as a last reso rt. Management of staff who have been abused \200 Debrie \201 ng by a manager to explore dis tress when staff are ready \200 Information about routes to crisis organizations and help lines will allow employees to choose a source appropriate for their needs. Specialist counseling (including therapeutic techniques) may be needed if employees are severely traumatized. Affected individuals often need help and support to seek redress from attackers. Involvement of the police can be helpful. Where necessary, offer access to legal advice regarding civil claims or compensation from the Criminal Injuries Compensation Board. Employees \200\231 responsibilities \200 Employees must try, wherever possible, to defuse violent situations \200 Report violent or aggressive incidents. 19_Smedley_Chap19.indd 388 1/2/2013 12:30:30 PM VIOLENCE MANAGEMENT POLICIES 389 Table 19.3 Examples of practical risk management Increased risk of violence Risk control Any jobs that involve public interface, especially if controlling or enforcing (e.g. traf \201 c wardens) Wide counters, barriers, security cameras, restricted access to work in areas for members o f the public Client group with risk factors for aggression: particularly, health care (ambulance workers , accident and emergency staff, mental health workers), custodial services (prison and prob ation of \201 cers) Assessment of individual client \200\231s potential for violent behavior should be a routin e part of the care or service plan Boredom, frustration, anxiety Environmental factors: avoid long waits for services, provide comfortable waiting rooms, ba sic refreshments, children \200\231s play areas. Inform clients about delays and explain th e reason Control and restraint tend to escalate violence Restraint techniques should be used only in extremes, as a last resort Alcohol and drugs Prohibit alcohol and drug use at high-risk events. Recognize intoxicated behaviors Cash transactions Avoid keeping large quantities of cash in work premises Lone or night working Avoid isolation. Have a means for lone workers to summon assistance. Pair-up staff for visi ts to high-risk clients. Ensure good lighting outside premises and in car parks Arrangements for reporting incidents The adverse event recording system must be clear to al l employees. Monitoring and review \200 Regular monitoring of incidents, and link to review of risk as sessments \200 Staff surveys and exit interviews of staff who resign help to de \201 ne the size and nature of the problem, and under-reporting of incidents. Further information and guidance Useful links (including some industry-speci \201 c guidan ce) are available via the HSE website. Available at: M http://www.hse.gov.uk/violence/information.htm The NHS Security Management Service gives sector-speci \201 c advice for health care. Avai lable at: M http://www.nhsbsa.nhs.uk/SecurityManagement.aspx Special rules apply to the restraint or treatment of patients with acute mental illness. Fu rther infor- mation is available in the Code of Practice, Mental Health Act 1983, revised 2008. NICE, (2005). Violence: the short-term management of disturbed/violent behavior in psychiat ric in-patient settings and emergency departments , NICE clinical guideline 25. NICE, London. 19_Smedley_Chap19.indd 389 1/2/2013 12:30:30 PM CHAPTER 19 Policies 390 Workplace smoking policies Current practice \200 Most employers have a policy on workplac e smoking. However, UK research suggests that many organizations, especially small employers, may not have a writt en policy to support smoking controls \200 Those workplaces to which the public has acces s (e.g. libraries, hospitals, shops) are more likely to have controls in place In some countries legislation has curtailed smoking in public places \200 Under the Healt h and Safety at Work etc. Act 1974 employers have a duty to protect worker \200\231s health and this includes passive smoking \200 Smoking is now banned in most indoor spaces, othe r than homes, including workplaces (e.g. vehicles) in the UK. Purpose \200 Concerns about employers \200\231 civil liabilities where non-smokers are ex posed to environmental tobacco smoke (ETS) at work have encouraged some employers to develo p and implement smoking controls There are many arguments against workplace smoking including breach of anti-smoking laws, a nnoyance to non-smokers, increased sickness absence among smokers, increased risk of \201 re, raised insurance costs, and in \202 ated cleaning and redecorating costs One of the strongest arguments against workplace smoking is that passive smoking may have a dverse effects on the health of some workers, especially pregnant workers, asthmatics, and COPD sufferers Smoking policy can aid corporate image. Main requirements \200 Set up a joint management \200\223staff committee to discuss smoki ng controls and to develop a draft smoking policy A clear timetable for policy development, obtaining staff feedback, revising the policy, an d implementing the \201 nal agreed policy should be made explicit at the outset of the pr ocess. The HSE recommend a minimum of 90 days for this process All employee groups should be represented, smokers and non-smokers alike. Union representatives, safety representatives, and members of the occupa tional health and safety team should be involved in the working group A draft policy should be drawn up, setting out the purpose of the smoking policy. Where restrictions on smoking are proposed, this may be a complete ban or a partial ban Where smoking is permitted, employees must smoke outside (this might affect evening/night shift workers \200\231 safety so this practice should be discour aged) Many NHS employers have banned smoking within hospital grounds Where smoking is permitted, this is usually only during scheduled tea or meal breaks. Alter natively, some employers allow smokers to work longer hours to make up for time lost due to smoking breaks 19_Smedley_Chap19.indd 390 1/2/2013 12:30:30 PM WORKPLACE SMOKING POLICIES 391 The policy should de \201 ne the responsibilities of supervisors to enforce the policy, an d identify sanctions for those breaching the policy, e.g. disciplinary action The employer may wish to offer support for those who wish to stop smoking in the policy (as part of Wellbeing strategy) in addition to that available via NHS Direct/GP The draft policy should be distributed to all staff for discussion and feedback It is sensible to provide information to staff regarding the adverse effects of smoking and the hazard of passive smoking, using lea \202 ets and posters To achieve optimum support for the policy it is important that the draft policy is well publicized using: \200 posters \200 staff e-mails/mailings \200 in-house magazine/newsletter \200 company intranet. Staff feedback can be obtained in many ways including: \200 Staff questionnaires \200 O pinion survey \200 Toolbox talks/staff brie \201 ngs \200 \200\230Town Hall \200\231 meetings. Implementation \200 Once the policy is agreed, further publicity is required to ensure th at: employees are aware of the new policy \200 know where smoking is banned \200 if smoking is permitted, staff know what restrictions are in place Some employers may opt to have a transitional period before full implementation of the workplace smoking policy The OH service may run a workplace smoking cessation program in support of the policy. The employer may fund nicotine replacement therapy (NRT) for those employees wishing to stop sm oking. NRT is now available on the NHS If smoking is to be permitted anywhere, then smoking and non-smoking areas should be designated, clearly signposted, and enforced. Audit Regular review of the effectiveness of the policy should be undertaken. Further information Action on Smoking and Health (ASH). Available at: M http://www.ash.org. uk/ NICE (2012). Brief interventions and referral for smoking cessation . Available at: M h ttp://www.nice. org.uk/PHI001 19_Smedley_Chap19.indd 391 1/2/2013 12:30:30 PM This page intentionally left blank 393 Chapter 20 Sickness absence, rehabilitation, and retirement Improving health and wellbeing through work 394 Sickness bene \201 ts 400 Sickness absence : general principles 402 Short-term sickness absence 404 Long-term sickness absence 406 Evi dence-based recovery times 408 Rehabilitation and disability services 410 Ill-health retire ment 412 20_Smedley_Chap20.indd 393 1/2/2013 12:31:50 PM CHAPTER 20 Sickness absence and rehabilitation 394 Improving health and wellbeing through work Health and unemployment There is good research evidence to suggest that unemployment is associ- ated with poor health. \200 Those who ar e out of work have an increased risk of: mortality from coronary vascular disease, cancers, suicide, accidents, and violence morbidity from depression, ischaemic heart disease \200 experiencing inequality in health and social opportunities In general, getting people back to work after illness or with disability is likely to bene \201 t their long-term health Long-term absence from work due to sickness has a poor prognosis. The likelihood of returni ng to work is 20% after 6mths of absence. Barriers to work and rehabilitation \200 Cultural beliefs about the right of sick people to be excused from work, and failure to recognize that work is bene \201 cial for most people \200 Pressure on GPs from patients or relatives to certi \201 cate absence from work, and dif \201 culty for GPs in declining to certi \201 cate Poor access to OH advice for many employees because of a shortage of OH professionals and other factors Employers \200\231 reluctance to arrange adjustments to work ( \200\230all or nothing \200 \231 mentality), or poor understanding about positive effects for business Lack of practical support for rehabilitation. Overcoming barriers to rehabilitation in the UK The drive to improve return to work and reh abilitation has been helped by changes in legislation, primarily the Equality Act. However, cultural atti- tudes are slow to change. Pro-active and co-ordinated effort is required fr om political and social drivers and a range of stakeholders. A compre- hensive description of solutions is beyond the scope of the handbook, but some broad approaches, current leads, and stakeholders are outlined here for reference. Broad approaches \200 Preventing ill health and injury in the workplace: general measures to improve the public health \200 maximizing opportunities to support he alth promotion at work \200 managing speci \201 c risks to health and safety at work Encouraging all doctors to consider return to work as part of the clinical management plan, including introduction of the \200\230 \201 t-note \200\230 (ne w Med 3 stating what work can be done by an employee, rather than automatically certi \201 cating off all work) Supporting employers to make adjustments to work \200 Improving access to OH advice 20_Smedley_Chap20.indd 394 1/2/2013 12:31:50 PM IMPROVING HEALTH AND WELLBEING THROUGH WORK 395 Improving the consistency and quality of OH advice ( b p. 352, Quality and audit in occupational practice 1: general principles; b p. 354, Quality and audit in oc cupational practice 2: systems and tools): \200 audit in OH practice \200 evidence-base d guidelines on OH issues \200 accreditation for quality and governance Providing work rehabilitation schemes for those who are off work long term due to ill healt h, particularly using a case management approach Promoting good HR practice. Government lead The White Paper \200\230Choosing Health \200 \231 1 shows leadership in tackling the bar- riers to retaining, regaining, or accessing wo rk. Work from a number of initiatives underpin this lead, including: \200 The Health, Wor k, and Well-being Unit: established in 2005, and jointly sponsored by the Department for Wo rk and Pensions (DWP), the Health and Safety Executive (HSE), the Department of Health (DH) , the Scottish Government and the Welsh Assembly Government. The unit: \200 promotes the link between good work and health \200 collates and adds to the evidence base \200 driv es change in this area The National Director for Health and Work has undertaken reviews, which outline relevant re commendations for improving health through work and for promoting early rehabilitation to w ork: \200 on the health of the working age population (2008, government response \200\224Improving health and work \200\224changing lives) on sickness absence, jointly with the Director General of the British Chambers of Commerce (2011, government response awaited). Other stakeholders \200 OH professionals and service providers \200 GPs and other healt h professionals, e.g. doctors in secondary care \200 Faculty and Society of Occupational Medicine, Royal Colleges \200 Employers and employers \200\231 organizations, e.g. Confed eration of British Industry (CBI), UK manufacturers \200\231 organization (EEF), NHS Employ ers \200 Employees and their representatives (e.g. trade unions), self-employed \200 Hu man resources professionals \200 Insurance companies \200 Local authorities \200 Volu ntary sector organizations. Table 20.1 lists the most important initiatives from the UK gov ernment and other stakeholders. It is not an exhaustive list. 1 Department of Health (2004). Choosing health: making healthier choices easier , Public He alth White Paper. Department of Health, London. 20_Smedley_Chap20.indd 395 1/2/2013 12:31:50 PM 2 0 _ S m e d l e y _ C h 3 9 6 a p 2 0 . i n d Table 20.1 Supporting prevention, rehabilitation and healthy working in the UK d C H A P T E R 3 Driver Strategy or initiative Description Web reference M http://www.dwp.gov. uk/policy/welfare-reform/ sickness-absence-review/ 9 6 Review of the sickness absence system in Great Britain to help combat the costs and impact of sickness absence Health and Work: an independent review of sickness absence National Director for Health and Work and Director General British Chambers of Commerce 2 0 S i c k n e s s M http://www.hse.gov.uk/ simple-health-safety/ HSE Health and Safety made simple 2011 Web-based guidance for employers on simplifying compliance with health and safety law a b s e n c e M http://www.dwp.gov.uk/ docs/good-health-and-safety.pdf DWP Good for Everyone. The next steps in the Government \200\231s plans for reform of the healt h and safety system in Britain 2011 Sets out a new start for health and safety regulation for businesses. Focus on deregulation for well-performing employers and making poorly performing employers bear the costs of ins pection and recti \201 cation of non-compliance a n d M http://www.dwp.gov.uk/ docs/hwwb-baseline-indicators. pdf Health, Work and Well-being Unit (DH, DWP, Scottish Govt., Welsh Assembly Govt) Health, Work and wellbeing Baseline Indicators Report 2010 Sets out the available baseline data for the indicators of health and wellbeing at work des cribed in Improving Health and Work: changing lives r e h a b i l i t a t i o n M http://www.hse.gov.uk/ strategy/strategy09.pdf HSE The Health and Safety of Great Britain//Be part of the strategy 2009 Sets out the HSE Board \200\231s strategy for the health and safety system, recognizing the role of stakeholders in maintaining and improving health and safety standards 1 / 2 / 2 0 1 3 1 2 : 3 1 : 5 0 P M 2 0 _ S m e d l e y _ C h a p 2 0 . i n d M http://www.dwp.gov.uk/ docs/hwwb-improving-health-an d-work-changing-lives.pdf M http://w ww.dwp.gov.uk/ docs/hwwb-working-for-a-healt hier-tomorrow.pdf d DH and DWP Improving Health and Work: changing lives 2008 The Government \200\231s response to Working for a Healthier Tomorrow 3 9 7 National Director for Health and Work Working for a Healthier Tomorrow 2008 Report on the health of the working age population, presented to the Secretary of State for Health and the Secretary of State for Work and Pensions I M P R O V N G I M http://www.dwp.gov. uk/healthcare-professional/ guidance/ DWP Information for professionals and advisers Various educational tools including desk-aids and web-based learning packages for doctors. Aimed at promoting good practice in relation to managing return to work after sickness or w ith disability H E A L T H A N D W M http://www.nhsplus.nhs.uk/ DH NHS Plus A network of NHS OH departments that provide OH advice to SMEs E L L B E N G M http://www.nhsplus.nhs.uk/ providers/members.asp DH NHS Health at Work Network Network of NHS OH providers, working in partnership with NHS Plus and NHS Employers to prom ote collaborative working and exemplary provision of OH services to NHS staff I T H R O U G H W O R K M http://www. workplacehealthconnect.co.uk/ HSE partnership Workplace Health Connect A free occupational health and safety advisory service for SMEs 1 / 2 / 3 9 7 2 0 1 3 1 2 : 3 1 : 5 0 P M CHAPTER 20 Sickness absence and rehabilitation 398 Further information DWP. Health and well-being unit \200\223 resources. Available at: M ht tp://www.dwp.gov.uk/ health-work-and-well-being/resources/ Advice for employers and employees on returning to healthy work. Healthy Working UK. Fit no te guide . Available at: M http://www.healthyworkinguk.co.uk/ Healthy working Wales. Availa ble at: M http://www.healthyworkingwales.com/splash_wales/ en.html Healthy working lives. Available at: M http://www.healthyworkinglives.com/ Advising patient s about work: an evidence-based approach for GPs and other health professionals. M http://w ww.dwp.gov.uk/docs/hwwb-health-work-gp-lea \202 et.pdf 20_Smedley_Chap20.indd 398 1/2/2013 12:31:51 PM This page intentionally left blank CHAPTER 20 Sickness absence and rehabilitation 400 Sickness bene \201 ts In the UK, state bene \201 ts are payable to those who cannot work due to illness. The process is summarized in Fig. 20.1. Statutory Sick Pay (SSP) or equivalent 1 \200 Payable by employer for spells of incapacit y <28wks \200 Certi \201 cated according to \201 tness for own occupation < 7 days, self-certi \201 cate SC1, SC2, or employers own form \200 >7 days, Med 3 (Stat ement of Fitness for Work) provided by GP or hospital doctor for out-patients or Med 10 provided by hospital doctor for hospital in-p atients. Includes advice on rehabilitation. State bene \201 ts 1 Employment and Support Allowance (ESA) \200 Entitlement depends on National Insurance (NI) contributions \200 Those who have not paid suf \201 cient NI, ma y qualify for income-based ESA depending on income and capital State bene \201 ts are subject to an assessment of work capability. Work Capability Assess ment (WCA) \200 Eligible when SSP ended, self-employed or unemployed \200 Assessment by a health professional +/ \200\223 medical assessment \200 Carried out during the \201 rst 13wks after application assessment of limited capability for work \200\224the focus is on what work activities the patient can carry out. The applicant has access to a personal adviser, training and condition management and is expected to move towards a return to work assessment of limited capability for work-related activity \200\224for the most severely affected, who are not expected to prepare for work GP no longer required to certi \201 cate if ESA awarded \200 The WCA assesses: the impact of health on daily life \200 the patient \200\231s view of the future from a h ealth and work perspective \200 activities the patient enjoys or would like to develop to help them move into work the support the patient feels they need to move into work Following WCA, support for those who are capable of work-related activities: \200 condition management program \200 expert health advice \200 workshop s on health topics, e.g. coping with pain, positive mood management, motivational support, preparing for work. 1 The newly published sickness absence review (21.11.11) proposes changes to the sickness a bsence and bene \201 ts system which will be subject to consideration and response by the UK gov- ernment during 2012. 20_Smedley_Chap20.indd 400 1/2/2013 12:31:51 PM SICKNESS BENEFITS 401 Self certifica- tion(cid:2)7days days Illness or injury, and off work SSP Assessment by GP or hospital doctor Med 3, Med 10 >7 days Support Group (not required to return to work) Work Capability Assessment by DWP ESA Work-related activity Group Specific support provided RETURN TO WORK Benefits Certification Fig 20.1 Summary of the process for assessing eligibility for bene \201 ts in relation to \201 tness for work 1 Further information and guidance For Occupational Health. Available at: M http://www.dwp.go v.uk/docs/ \201 tnote-occupational-hea lth-guide.pdf For GPs. Available at: M http://www.dwp.gov.uk/docs/esa-gp-lea \202 et.pdf; Also available at: M http:// www.dwp.gov.uk/docs/gp-bene \201 t-guide.pdf; Also available at: M http://w ww.dwp.gov.uk/docs/ \201 tnote-gp-guide.pdf 20_Smedley_Chap20.indd 401 1/2/2013 12:31:51 PM CHAPTER 20 Sickness absence and rehabilitation 402 Sickness absence: general principles De \201 nition and size of the problem Sickness absen ce is de \201 ned as any absence from work attributed to illness or injury, and accepted a s such by the employer. It gives rise to signi \201 cant costs for all organizations. The Confederation of British Industry (CBI) estimate that in the UK, nearly 190 million working days were lost due to sickness in 2010, at a cost of 17bn. 1 That survey found absence l evels of 8.1 days per public sector employee and 5.9 days per private sector employee. Howe ver, evidence from HSE suggests that differences between the public and private sectors are small, and may be partly explained by under-reporting in small private sector organization s. (cid:2) Estimates of the proportion of sickness absence actually due to non-medical reas ons vary widely ( 10% up to 30%) and should be viewed with great caution. Determining what proportion of sickness absence is not genuine is, for obvious reasons, very dif \201 cult. Risk factors for sickness absence Absence rates tend to be higher: \200 Among women compa red with men \200 In older workers (total days of absence), although young workers have more spells of short-term absence In larger compared with smaller organizations \200 In the public sector compared to priva te industry (but note that the public sector employs more women and older workers and comprises mostly large organizations ). Patterns of sickness absence \200 Short-term: frequent short-term absence is most commonly due to minor unrelated self-limiting illness o r injury, although it can indicate chronic underlying ill health however, it can mask non-medical absence Long-term: almost invariably due to signi \201 cant medium- to long-term ill health Because of this general difference in the nature of short- and long-term absence, the broad approach to management also differs. See b p. 404, Short-term sickness absence; b p. 406, Long-term sickness absence). Measurement of sickness absence Simply counting hours or days lost as a proportion of total days worked by all staff ( crude absence rate ) may be misleading and does not show whethe r the main issue is short or long term absence. \200 Frequency rate: shows the mean numbe r of absences per worker as a percentage. (No. spells of absence in the period/No. employees) \227 100 1 CBI-P \201 zer Absence Survey 2011. 20_Smedley_Chap20.indd 402 1/2/2013 12:31:51 PM SICKNESS ABSENCE: GENERAL PRINCIPLES 403 Lost time rate: measures the mean number of working days lost as a percentage of total working days. [Total no. working days lost due to absence in a year/(Working days in year \227 total no. employees)] \227 100 The lost time rate can be calculated across the company or for speci \201 c business units or by trade/profession, thus highlighting \200\230hotspots \200\231 of poor attendance. T his calculation can also be made for lost hours rather than lost days \200\224useful for em ployers with a large number of part-time staff. Bradford score S 2 \227 D Where S is the number of spells of absence and D is the number of days of absence in a give n time period (e.g. rolling 52-wk interval). The Bradford score is calculated for each worker individually. It high- lights the disrupti on caused by repeated short-term absence by weighting the number of episodes (or spells) of absence. For example, \200 Twelve 1-day absences: 12 \227 12 \227 12 = 1728 \200 One 12-day absence: 1 \227 1 \227 12 = 12 \200 Three 1-day absences: 3 \227 3 \227 3 = 2 7 \200 One 3-day absence: 1 \227 1 \227 3 = 3 The Bradford score may be used to set a t hreshold for case management so that consistency in approach between employees can be demon strated. The threshold score can be based on the extreme of the distribution (upper 5 \200 \22310% of all scores) rather than an absolute total score, avoiding the perception of a \200\230safe score \200\231 among employees. This measure tends to be used in organizations where most staff works shifts and short-term absence is more disruptive than long-term abs ence. Further information HSE (2005). Survey of workplace absence sickness and (ill) health (SWASH) . Available at: M http:// www.hse.gov.uk/sicknessabsence/ CBI absence survey 2011 M http://www.cbi.org.uk/media/955604/2011.05-healthy_returns_-_ absence_and_workplace_health_survey_2011.pdf 20_Smedley_Chap20.indd 403 1/2/2013 12:31:51 PM CHAPTER 20 Sickness absence and rehabilitation 404 Short-term sickness absence 2 Frequent short-term term absence is usually regarded as a man agement issue. The input from OH professionals generally has a different focus compared wit h long-term absence.