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Why we all need to be able to ask for help – like David in the Bodyguard

‘I’m David and I need some help’ – in the powerful penultimate scene of the BBCs bodyguard we see David, having saved the day, head into Occupational Health and ask for help.

Occupational Health is the backbone of a healthy workforce, and as we have seen in the Bodyguard – in many organisations they are there to support workers in the most extreme of circumstances. One third of all our Occupational Medicine trainee doctors train in the Armed Forces, supporting those who train for and experience armed conflict first hand. There are large occupational health teams in the Police, Transport for London and Fire Service.

Professor Neil Greenberg, a consultant occupational and forensic psychiatrist who served in the United Kingdom Armed Forces for more than 23 years and has deployed, as a psychiatrist and researcher, in a number of hostile environments including Afghanistan and Iraq says;

“Occupational health physicians play a vital role in supporting the mental health of employees. It is very common that employees are concerned about seeking help because they fear being stigmatised or viewed as being weak or incompetent. In the BBC’s the Bodyguard, David repeatedly turned down offers by his colleagues and managers for them to send him to occupational health.

Luckily for David, and of course the viewers, his mental health difficulties did not stop him from uncovering the wrongdoings of corrupt senior officers. However, in reality people who have substantial mental health problems often do not perform to the high standard that David did. Where employees trust occupational health services to ‘have their back’ and consider that the Occupational physician will help them fight their corner to get the treatment they need whilst safeguarding their jobs, everyone wins. We can already see a fitter, more resilient David thanks to the great care he receives from his occupational health department!”

But the number of trained specialist doctors are falling, and the majority of small and medium sized organisations don’t have access to occupational health.

The Society of Occupational Medicine are calling for universal access to occupational health – because we all might at some point need help, but hopefully not in quite so dramatic fashion as David!


Health Surveillance - what your duties are (and what you need to do) as an employer

First published on  

By Pippa Crouch

Health Surveillance

The role of Occupational Health (OH) is to support the employee throughout their employment, from assessing a candidate’s fitness to work on commencement of post to ensuring that support is offered in accordance with the relevant legislation.

OH acts in an advisory capacity offering advice to managers to support their employees and help them, where possible, to remain in the workplace. It aims to safeguard the health of the employee by offering health surveillance, determined by statute and best practice, to ensure that the roles and duties do not cause any adverse effects on health as a result. This month’s blog will provide an overview of the types of health surveillance required and covers what your duties are (and what you need to do) as an employer.

1) Health Surveillance Programmes

Health Surveillance is an activity which captures information about worker’s health in relation to the work they undertake. The value and purpose of this is to protect the health of the worker through early detection of any health conditions and to identify the requirement for any specific monitoring. It also evaluates the efficacy of existing control measures and demonstrates compliance.

The need for any health surveillance will either be identified as part of the health risk assessment, through good practice (for example fitness to work in some roles) or as a legal requirement. Where the risk cannot be eliminated or reduced further health surveillance may be considered however it is not a substitute for controlling the health risk.

Any health surveillance will be undertaken by a suitably qualified and competent medical practitioner or responsible person and all medical records will be kept in accordance with the Data Protection Act (1998).

Health surveillance can take many different forms from non-technical surveillance such as questionnaires and skin surveillance to technical forms such as hearing checks (audiometry) and lung function testing. Any health surveillance undertaken is in the least invasive form possible and is always explained in full to the individual.

2) When is it Completed and by whom?

The frequency of health surveillance is determined by the level of exposure and accepted guidelines. It can be on commencement of a position and at regular intervals thereafter and sometimes exit surveillance is required when an employee leaves employment.

Some health surveillance takes the form of self-assessment as part of a wider programme and workers may be asked to complete a questionnaire which is reviewed by OH.

For more technical assessments the employee will need to be referred into OH where a doctor, nurse or technician will perform the various tests and examinations.

3) Types of Exposure/ Health Surveillance Required

3.1) Display Screen Equipment (DSE)
Under the Health and Safety (Display Screen Equipment) Regulations 1992 there is a requirement for those identified as users (for example anyone who uses a visual display screen as a significant part of their day) to have an assessment of their DSE set up. Usually this can be conducted locally by a suitably trained DSE assessor or via a self-assessment process with OH providing specialist ergonomic or tertiary support (as part of an escalation process). Here at Global OHS we can offer DSE assessors training as well as specialised ergonomic support and workplace assessments.

3.2) Chemical and Hazardous Substances
In areas where hazardous substances cannot be substituted for less harmful substances then COSHH risk assessment must be undertaken to reduce any risks to staff from exposure. All staff must receive appropriate training on the control measures introduced. When a COSHH risk assessment indicates that health surveillance is necessary as a control measure is when workers(s) are exposed to harmful substances over the workplace exposure limits. The main examples of these are;

• Flour/grain - baking and milling
• Glutaraldehyde/ formaldehyde – used in disinfecting and tissue fixing.
• Isocyanides (paints) – spray painting,
• Some glues and resin – used in curing
• Latex – protective gloves used in health/home care
• Soaps and cleaners – cleaning roles
• Wet work – Gardening/ rescue relief
• Any product marked R43 ‘May cause sensitisation by skin contact’, or R42/43 ‘May cause sensitisation by inhalation and skin contact’.

Health surveillance may consist of skin surveillance and/or respiratory surveillance.

3.3) Skin Surveillance & Respiratory Surveillance
Some chemicals, materials and fluids can lead to skin sensitization, irritation and occupational dermatitis. A reaction can build up over time or can occur immediately after a small exposure. Some symptoms can be treated easily and some reactions may result in longer term issues. The frequency of skin surveillance should be undertaken in accordance with the risk assessment; however for those considered to be exposed it is recommended that they are assessed six weeks into work by a responsible and competent person with regular checks thereafter.

Respiratory surveillance is required where there is an exposure to a respiratory sensitizer which can lead to occupational asthma. Again regular and periodic surveillance is advised, usually at six and twelve weeks after commencement of work and periodically thereafter.

3.4) Vaccinations and Immunisations
Vaccination against some biological agents can be provided as a control measure. Occupational immunization is only required when the risk assessment determines employees can reasonably expected to be exposed to infectious diseases in their workplace. Typical examples include grounds people, sewage workers, healthcare and laboratory staff, animal handlers and those working overseas where some vaccine preventable infections are endemic. It is important to note that immunisations are not available for all biological agents and they should not be used as a substitute for effective control measures.

Exposure to biological agents can include;

• Blood borne viruses, HIV or Hepatitis B and C
• Leptospirosis
• Legionella
• Tuberculosis
• Influenza in frontline staff

The Department of Health (DoH) defines frontline healthcare workers as those involved in direct patient care, regular clinical contact and involved in the delivery of personal care.

Any vaccine-preventable disease that is transmissible from person to person poses a risk to both the worker and their service users. Healthcare workers have a duty of care towards their patients which includes taking reasonable precautions to protect them from communicable disease, and employers have an obligation to arrange and pay for this service.

It is recommended that immunisation programmes are managed by OH services with appropriately qualified specialists. Therefore from an immunisation perspective they should be vaccinated in accordance to the DoH’s Green Book: Immunisations against infectious diseases, following specific work-related risk assessments.

Immunisation is only a control method and, following occupational immunisation, managers as well as the workers themselves need to have sufficient information and understanding about the outcome of the vaccinations to make appropriate decisions, i.e. in the event of an exposure.

All healthcare workers with contact with blood and blood stained body fluids should be offered immunisation against hepatitis B and antibody testing to assess response. In addition, those organisations who operate independently to NHS trusts and are unlikely to be considered an emanation of the state and therefore it is unlikely that these guidelines will apply directly, however if NHS patients are supported in these independent settings the DoH advise that this guidance is followed. Likewise Independent Health Care the National Minimum Standards include access to OH and appropriate pre-employment screening (for employed staff). Independent hospitals, hospices and clinics are recommended to follow this guidance as such facilities are required to comply with the Independent Health Care Regulations (NI) 2005, Regulation 15.7 of which describes duties to minimise the risk of infection. Furthermore, implementation of this guidance is likely to ensure compliance with certain requirements of future DHSSPS minimum standards. In Northern Ireland the Regulation and Quality Improvement Authority (RQIA) is the body responsible for the enforcement of these regulations and standards

3.5) Noise Exposure
The Control of Noise at Work Regulations 2005 places a duty on the employer to reduce or prevent exposure to noise at work. From 2008 these regulations also apply to those in the music and entertainment business and apply to those who are exposed to a wide audio range.
It applies to;

• All workers working in defined hearing protection zones or regularly exposed to an averaged exposure over 85 dBA.
• Those workers regularly exposed to between 80 and 85 dBA (first action level) identified as being sensitive to noise induced hearing loss.

These workers will require audiometry to ensure that the exposure does not cause any damage to the employee’s hearing. Noise Induced Hearing Loss is one of the most prevalent and irreversible industrial diseases and the HSE recommend a full risk assessment programme, ensuring comprehensive hearing protection, reduction and restriction. A baseline hearing check (audiogram) and subsequent regular hearing checks are suggested for employees who are exposed.

3.6) Hand Arm and Total Body Vibration
Exposure to vibration at work can occur in two main ways:

• hand-transmitted vibration (known as hand-arm vibration or HAV) and
• vibration transmitted through the seat or feet (known as whole-body vibration or WBV).

Hand-arm vibration is vibration transmitted from work processes into workers' hands and arms. It can be caused by operating hand-held power tools such as road breakers and hand-guided equipment such strimmers.

It can become hazardous to health when employees are (excessively) exposed and this may result in permanent effects such as hand arm vibration syndrome, white finger and carpal tunnel syndrome occurring. Occasional, low level exposure is unlikely to cause ill-health effects.

Where it is impossible to eliminate the use of vibrating equipment a hand arm vibration health surveillance programme should be in place. A 5 tiered system is used as determined by the level of exposure and those exposed in the workplace will need statutory health surveillance by OH.

3.7) Night Worker Assessments
The Working Time Regulations 1999 require that all night workers are offered a health assessment either whilst working on night duty or prior to commencement of night duty. This is usually done via a questionnaire upon commencement and then annually. This forms part of a process to ensure that workers with health conditions are adequately supported in the workplace.

Any worker who regularly works over three hours during the core night period between 11pm and 6am would need to be offered an assessment upon commencement of role. Whilst there is a duty on employers to offer the assessments, completion is on a purely voluntary basis.

The working time regulation apply to “workers” and encompassing more than just employees and as a best practice measure any worker who meets the definition should be offered a health assessment including any volunteers that your company may employ.

3.8) Vocational Driving
The Driving Vehicle and Licencing Agency (DVLA) require different standards of fitness which are determined by the class of vehicle and driving conditions. In summary Group 1 license is an ordinary driver’s license which permits the holder to generally drive cars and vans up to 7.5 tones in weight and minibuses. There are some medical conditions which need to be declared and some will bar the holder from driving. A simple eye check up to age 70 needs to be demonstrated. Research by Brake, the road safety charity has determined that up to 40% of vision can be lost before it becomes noticeable. It is estimated that 12.5 million people in the UK are due an eyesight test and poor vision is believed to be responsible for up to 2,900 accidents each year.

Those driving minibuses (not for hire or reward) will need to apply for Group 2 licenses over the age of 70. A driver over 70 years old without the 79 (NFHR) / 01 / 101 codes against either their D1 or B entitlement cannot drive a minibus under any circumstance. Those driving on Group 2 licenses are HGV or public service vehicles. Group 2 lasts until age 45, then at regular intervals after this. DVLA regulations state that group two and three licence holders need to undergo a fitness check due to the potentially more serious consequences of an accident. It is considered to be good practice for all fork lift truck operators and potential operators to be screened for fitness before employment and again at regular intervals in middle age and that a medical is necessary to assess their locomotors, vision, and hearing skills.

3.9) Lone Worker and Confined Spaces Assessments
Lone workers are those who work by themselves without close or direct supervision and the purpose of the assessment is to ensure that they are medically fit to work alone.

Confined space means a space that has any of the following characteristics:

• Limited openings for entry and exit;
• Unfavourable natural ventilation;
• Not designed for continuous worker occupancy

It is not a legal requirement to have confined space medicals, however working in confined spaces is subject to the Management of Health and Safety at Work Regulations 1999, and it is considered good practice to have a medical assessment prior to letting anyone work in a confined space.

4) HSE Approved Medicals

4.1) Asbestos Medicals
The 2012 asbestos regulations prohibit the use, import and supply of asbestos. If you are a duty holder or have responsibility for a building then any asbestos contained within it must be treated according to the regulations. Since 2015 there is an explicit duty to risk assess the likelihood of exposure and in cases where exposure exceeds the control measure medicals will be required every three years by OH.

4.2) Lead Medicals
There is a legal requirement to monitor those exposed to lead. It cannot be absorbed through the skin but can be inhaled (as vapour/ fumes/ dust) or ingested as lead poisoning may occur.

The HSE require organisations to monitor lead levels and maintain a health register for everyone engaged in potentially hazardous processes.

5) Health Risk Assessments

This blog has hopefully highlighted that the importance for the health risks to be considered when undertaking or reviewing your companies risk assessments. Here at Global OHS we have vast experience of supporting companies in both writing and reviewing their local health surveillance policies and procedures with regards to health risk assessments. In addition we can act in an advisory capacity with the assessment process in which the job roles are reviewed to determine the health checks and fitness standards that may be required.

It is good practice to regularly review your risk assessments to determine if health surveillance is still required as for example, technological advances often result in new processes that reduce noise exposure, or improved extraction systems reduce the exposure to respiratory sensitizers.

Read more about Pippa and her background in occupational health.



8.9 million working days lost to work related musculoskeletal disorders

In 2016/17 507,000 workers suffered for work related musculoskeletal disorders (MSK) losing 8.9 million working days. Construction, transport and storage, health and social work activities and agriculture have the highest rates.

There is a general downward trend since 2001 but still approximately 1500 in every 100 000 workers have a new or longstanding MSK disorders annually.

In 2016/17, the following working days were lost due to work-related MSK issues

• Back disorders - 3.2 million days with an average number of days lost per case of 16.5 days, 

• Work Related Upper Limb Disorders (WRULDs) - 3.9 million working days lost, this equated to 17.2 days per case

• Work Related Lower Limb Disorders - 1.8 million days were lost with a rate of 21.1 days lost per case.

Men are more likely than women to get MSK disorders and they become more common the older we get.

And not just in the UK, according to the latest figures of the European Survey on Working Conditions, 24.7% of the European workers complain of backache, 22.8% of muscular pains, 45.5% report working in painful or tiring positions while 35% are required to handle heavy loads in their work. Pain in the lower limbs may be as important as pain in the upper limbs, although this is less commonly reported in the recognised occupational musculoskeletal disease reporting systems. 

And it’s not a standalone problem; evidence shows MSK disorders cross- react with mental health issues.

Perceived work environment influenced psychological distress and also influenced the reporting of MSK disorders. The mechanism is thought to be that adverse psychosocial environments may impair coping behaviours, leading in turn to impaired mental health, tension, and consequent MSK symptoms. Studies have shown that ‘abnormal’ scores on a measure of psychological distress precede, rather than affect, episodes of back pain and a 10 year follow up study showed that psychological distress at baseline (23 years) more than doubled the later risk of low back pain at age 33 years. Therefore, psychological distress is highlighted as a primary cause, rather than an outcome, of MSK pain. 

There are many causes of MSK symptoms, but obesity consistently appears in studies as a key factor in the onset and progression of conditions of the hip, knee, ankle, foot and shoulder. The majority of research has focused on the impact of obesity on bone and joint disorders, such as the risk of fracture and osteoarthritis. However, emerging evidence indicates that obesity may also have a profound effect on soft-tissue structures, such as tendon and cartilage. 

Obesity substantially increases the risk of OA and other MSK conditions such as back pain, with the risk of developing knee arthritis appearing to be similar to that of developing high blood pressure or Type 2 Diabetes. Those who are obese are twice as likely to get osteoarthritis of the knee than those of recommended weight and the very obese are 14 times more likely to develop persistent knee pain than slim individuals.

So, what does this mean for businesses?

At its most basic, the older and fatter we get, the more likely we are to get MSK disorders and if we have mental health issues that will also increase the problem. The general population is getting older and the number of young workers is decreasing, and they are fatter than they have ever been. This shows no signs of improving as there is a large percentage of obese school children. Obesity is increasing in the population of the UK and as we all know we are all going to have to work for longer. Mental health problems are also increasing in frequency in the population with a significant number of people first affected in childhood.

A perfect storm of future problems for businesses. 

A wellbeing strategy that addresses mental health, physical health and proactive health initiatives is needed by organisations now more than ever and access to sound Occupational Health (OH) provision for employees helps with managing all these issues.

Occupational Health (OH) is a branch of healthcare that is concerned with the relationship and interaction between health and work.  An effective OH service aims to achieve the following.

• Protect workers against work related health risks

• Monitor the health of workers with specific health checks over time

• Ensure the fitness of workers to work safely and effectively

• Reduce absence due to work related and non-work related illness

• Advise on rehabilitation programmes after long term illness or injury

• Enhance preventive and proactive wellbeing through health education, skills development and promotional programmes

The climate of employment means that organisations need to consider how they are going to address the upcoming demographic and fitness issues that are predicted to be arriving now and in the next decade. Return on Investment (ROI) for OH is especially easy to measure around MSK with figures ranging £5-11 benefit for every £1 spent. For general wellbeing interventions the ROI is between 1:1 to 34:1 but the studies are of variable quality.

But considering the risk to business, the question now needs to move from what is the ROI a business gets from its investment in the health of its staff to what is the risk from not investing. With all the evidence now available about the public health risks and an aging workforce, the question a responsible business should be asking should not be “Why should we invest in OH advice and intervention?” but now the question really must be “What possible reason is there for not investing in OH advice and intervention?”


Dr Lucy Wright

Chief Medical Officer Optima Health on behalf of the Society of Occupational Medicine




Mental Health Research

We are pleased that two key articles from the journal, Occupational Medicine, have been included in a collaboration of notable articles on mental health. The research covers a wide-range of areas including music therapy, sleep, age and the brain. 

One is on Working hours and common mental disorders in English police officers and the other is Impact of working hours on sleep and mental health.   

The full selection of articles can be found online



by Dr Richard Heron

Our health is always with us. We track it with phone apps, talk about it with friends and family and make toasts to it on special occasions. And just like people on the whole, our health fluctuates and changes from day to day, week to week and year to year.

Sometimes we are in excellent health, untroubled by the events around us and performing at our best at home and at work. At other times our physical or mental health can take a dip. We may be troubled or stressed by events that are out of our control, or our physical health can be impaired by a strain or sprain.

Small problems can knock our confidence, as we find it more difficult to think or move as easily as before. At the other end of the spectrum, up to one in four of us each year may need additional help to address a more serious mental health problem such as anxiety or depression, or we might develop a more complex physical illness that needs clinical attention.

Most of us wouldn’t think twice about discussing a broken arm or bout of flu with a colleague, but we find it much more difficult to talk about our mental health at work. This is why Mental Health Awareness Week is so important. 

This week provides a helpful reminder to normalise the conversation about mental health and to reduce the stigma associated with mental ill health. For many people the majority of their waking hours are spent at work, making the workplace an important setting to address mental as well as physical health matters. 

When it comes to mental health, starting a simple conversation with a colleague we are worried about demonstrates that we have noticed them and that we care. It could be the first step towards getting them the help they need, to addressing factors in the workplace that could help or hinder recovery and for some it could even be a life-saver.

Whenever we are stricken by illness or face the more difficult moments in our lives, the importance of empathy, by someone who genuinely cares, putting themselves in our shoes and listening to us without judgement cannot be underestimated. 

Could this someone be you, a friend, a co-worker or a manager? Could you help someone make that first call to an Employee Assistance Programme or occupational health professional if you have one at work? Early interventions can help co-workers back to health and help them to stay engaged in productive work – a healthy outcome for employee and employer alike.

For more information we recommend:


Government response to the review of modern employment practices

The government has responded to The Taylor Review of Modern Working Practices.


The full government response can be found here. The Health and Wellbeing at Work section of the document can be found on pages 59-60 and the following summary on page 12: "The shape and content of work and individual health and well-being are strongly related. For the benefit of firms, workers and the public interest we need to develop a more proactive approach to workplace health". 


In addition to the government response, four consultation documents have been published. The documents explore in detail some of the recommendations made by the review. 


Prof. Diana Kloss MBE on Brexit and occupational health and safe

Prof. Diana Kloss recently spoke to the North West Society of Occupational Medicine regional group on the impact of Brexit at the Bentley Motors factory in Crewe.

In her talk Prof. Kloss explained the legal position of the government and its relationship to Parliament and the courts. She reviewed the White Paper on the Great Repeal Bill and tried to predict what new legislation will be needed.  She emphasised that workers' rights both in health and safety and employment law were enshrined in law both before the UK joined the EU, and during UK  membership and that these rights may be reviewed after the UK leaves.

In particular, some provisions of the Working Time Regulations, the Agency Regulations and TUPE are unpopular with business and may be amended.  Special consideration was given to the General Data Protection Regulation which will come into force throughout the EU in May 2018.  It is likely that the UK will need to make substantial amendments to the Data Protection Act.

Members were impressed by the Occupational Health (OH) service provided by Bentley, including access to physiotherapy in the workplace and counselling through an Employee Assistance Programme.  This was a great example of the diversity of working in OH. To join the SOM NW Group go to

Diana Kloss is a barrister and part-time chairman of Employment Tribunals in Manchester. She is also an Honorary Senior Lecturer in Occupational Health Law at the University of Manchester.

Diana will also be speaking at an event on the implications of Brexit on UK workplace/workforce health on 10th May. See


North West

Alice's Story

As illustrated by Alice’s story, it is important to assess employees post-offer when they have significant medical conditions which might impact on work.  Adjustments made at this time has the potential to prevent any adverse effect on their impairment and maximize their potential for work. Evidence has shown early intervention services are far more successful at maintaining employees being engaged, productive and well, than referrals to occupational health after the employee has been off work on sick leave for 4 weeks or more and it is likely to be even more effective if a preventive approach is taken.



Tri service occupational health symposium – March

Sandhurst Military Academy

Held every two years, this event at Sandhurst Military Academy brings together occupational health and medicine professionals working in the armed forces. A key note address from the Chief of Defence People, Lt Gen Richard Nugee, on the first day outlined the challenge: to ensure the maximum number of military personnel are fully deployable. As part of this objective, military occupational health practice helps protect, promote and restore health ensuring medical fitness to both employ and deploy soldier sailors and airmen (common issues being mental health and musculoskeletal injuries). Thankfully, all military personnel have access to good quality occupational health, whereas in the civilian population this is not the case.

Dr Robin Cordell has worked both in the military and civilian sectors and compared occupational health practice between the two. He highlighted the enduring importance of leadership. Workplace health problems can arise wherever there is poor leadership and team functioning. It was reassuring to hear that a core part of the training at Sandhurst is to support a leadership style that serves and aims to improve team dynamics and interpersonal relationships. He also highlighted that military occupational health has unique challenges, hazards and risks such as with the equipment used. Whereas private sector occupational health services have a commercial imperative, in the armed forces there is a shared outcome of facilitating return to work / being deployable for operations.

The first day also covered current issues in the military workforce: women fighting in ground close combat, transgender issues and women as submariners.  I was impressed as to how military occupation health professionals also provide a significant contribution to the broader OM community –through an impressive investment in training of the next generation of professionals and undertaking research. There were some excellent research presentations - for example, examining if there is there a link between higher body mass index and fitness for deployment - is it that the bigger you are the more likely you were going to be unfit to be deployed? The results confirmed that is the case, and that excess weight and obesity effectively cost the Royal Navy 108 deployable bodies – a whole ship of people! However, it was reassuring to know that if the Royal Navy’s population was the same weight as the UK’s population there would be significantly more men unfit to deploy. Other research suggested that recruiting standards should be maintained and that efforts should be made to reduce obesity as this can also lead to increased risk of injury.

Nick Pahl, SOM CEO

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