1. 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

2. Royal Army Medical Corps Cadetships Final 3 yrs at Medical School Final 3 yrs at Medical School Annual Salary £12,500 - £15,000 Annual Salary £12,500 - £15,000 Tuition fees paid & Book Allowance Tuition fees paid & Book Allowance Clinical and Academic support Clinical and Academic support Elective Placements abroad Elective Placements abroad Package worth about £42,000 Package worth about £42,000 Excellent training prospects after graduation Excellent training prospects after graduation Enquiries: 01276 - 412744/45 Enquiries: 01276 - 412744/45

3. Learning Points Recap – Role of OH Team Defining the scale of the problem Identifying & Assessing Ill-health in the Workplace DDA Fitness to Drive

4. 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.

5. 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.

6. Extent of Sickness Absence and Occupational IIl Health in UK Annual bill for GB work related illness and injury is £10 Billion Musculo-skeletal conditions £5.5 billion Averaged absence per employee 7.8 days Averaged cost per employee £400 - 500 2 Million believe they are suffering from illness, caused by work

7. OH Stakeholders Individual -Employee -Patient Work -Colleagues -Employer -Customers -Investors -Public Society -Family & Community -Health Service -Country/Govt -Legislators -Media? And don’t forget... YOU and I!

8. Occupational Health Tasks Identify hazards Identify hazards Assess risks to health in the circumstances Assess risks to health in the circumstances Manage/control the risks Manage/control the risks Match people with appropriate jobs Match people with appropriate jobs

9. 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

10. Hazards/Exposures  Chemical  Physical  Mechanical  Biological  Psycho-social/Organisational

11. Matching Jobs and People People: Health/Fitness, Susceptibilities People: Health/Fitness, Susceptibilities Jobs: Ergonomics + Minimising Risks Jobs: Ergonomics + Minimising Risks Psychosocial: Work-Life balance, Stress Psychosocial: Work-Life balance, Stress Evidence Based Standards Evidence Based Standards Common Sense Common Sense

13. 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’

14. Impact of Illness at Work Increased risks to the Individual Increased risks to Colleagues Decreased Productivity Infection AccidentsInjuryWorkloadAnxiety Litigation Risks

15. Illness at Work Coincidental / Inter-current Index cases Exacerbated by Work Resultant from Work

16. Matching the Person to the Job Functional Assessment Capability Based ‘Reasonable Adjustments’ –Physical/Ergonomic –Psychosocial/Organisational Alternative Employment (Medical Retirement)

17. Medical Screening Pre-Employment/Pre-Placement Initial Training Periodic Change of Employment Clinical Indications Return to Work/ Prolonged Sickness Absence Retirement

18. How do you Screen? Questionnaire –Self Administered –OH Nurse Administered –Doctor Administered History & Examination –Doctor or OH Nurse led Investigations

19. 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

20. Maintaining Fitness for Work Medical Assessment/Medical Screening Advice to Management Company Health Policies Worker (& Management) Education Health Promotion

21. Fitness to Drive

22. Health & Driving DVLA Concerns - Sudden incapacity Legal Basis/Statute - Road Traffic Act 1988 - EC Directives - Human Rights Act Medical Obligations - Individual - Doctor

23. 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

24. 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

25. 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

26. 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

27. 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)

28. Driving Licences Medical Obligations –Road Traffic Act –Risk Management (Sudden Incapacity) –Reporting to DVLA –Confidentiality

29. 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

30. 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

31. 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.

32. 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