Group therapy

What have OH services based in Sheffield, Rotherham, Barnsley, Bradford, North Derbyshire, Liverpool, London, Leeds, the Black Country and Kirklees all got in common? They are all members of the National Work and Health Network, a group of independent occupational health and safety providers that is now aiming to collaborate with other local providers to extend the network across the country.

Some of the local projects have been running for more than 20 years in partnership with a range of local organisations from primary care trusts (PCTs) to Chambers of Commerce, trade unions, local authorities and academic institutions. Evaluations show they have had significant success in areas such as workplace health improvements, return-to-work initiatives and sickness absence reduction.

Sheffield OH Advisory Service

The Sheffield Occupational Health Advisory Service has been running for 24 years, says senior adviser Simon Pickvance, who has been with the project since 1979. Its core activity has been running services from GP surgeries. It has focused on black and ethnic minorities, home workers, advice for pregnant women and other groups who have not had access to occupational health.

“We’ve always tried to look at the sector of the workforce who are not getting help in other ways – farm workers for example,” says Pickvance.

“The work we have done has set out to reach the 80% of the workforce who don’t have access to OH, but we are unapologetic about being reactive. All workplaces have prevention services, but that’s not what happens. We see people that have health problems caused by work. Risk assessment often misses people who conceal illnesses because of fear. Currently, the quality of work issues are very important,” he says.

“What people are doing now is often poor quality work, such as call centres and cleaning, where there is a combination of low pay, long hours and high risk.”

Pickvance highlights the plight of older workers as another area where projects will need to focus their work. “The pressure on older workers to remain at work for financial reasons is going to intensify,” he says. “Older people are going to need a major redesign of work in order to continue to work safely. We need to view ageing as a new way of looking at disability and deprivation.”

Pickvance believes the latest wave of ethnic minorities in the workforce are also going to need help. “Even workplace deaths may be going unrecorded among these groups,” he claims. “If they get an injury, they are so insecure in terms of their employment status that they don’t seek help.”

Pickvance points to the ongoing Department for Work and Pensions (DWP) Pathways to Work pilots as evidence of the effectiveness of the network’s approach to workplace health.

“There has been a business case for some of the things we like to see take place,” he says. He believes the way forward is to build oOH into comprehensive health provision. “You have to be where everybody goes when they need help and that is a primary care setting,” he says.

Health @ Work Liverpool

In Liverpool, Frances Molloy, director of Health @ Work Liverpool is also a champion of delivering care through a primary care setting.

Health @ Work Liverpool was set up in 1993 and provides a broad range of advice on occupational health and safety in a number of different settings including an adviser based at the Chamber of Commerce, but the core of its work is primary care support.

Health @ Work is contracted by the PCT to provide occupational health and safety advice for six GP practices. “They refer in patients who need our help,” says Molloy. “Some refer in straightaway, as soon as they reach for the sicknote, and we try to give good advice about how to return to work. It doesn’t matter how the illness or injury happened. It may have been a car accident or some other non work-related problem, but we can facilitate return to work in an efficient way.’

How do employers deal with a third party approach of this kind? “Some employers can be a bit defensive when you write and say you are dealing with one of their employees”, Molloy admits. “But a lot say thank you for letting them know about the situation. Most employers want to be good employers but often they don’t know how. They don’t know what they need to do to help their employee back to work and they are grateful when we suggest things. When we write and say the employee has identified these issues, the business will often say we didn’t know there was a problem but we will sort it out.”

Molloy sees the role of Health @ Work as a facilitator in establishing good communication between employee and employer. “We are empowering individuals to sort out their own problems, having an intermediary is important because sometimes employees are too frightened to report problems to occupational health because it is perceived as a management tool and they think they might be in trouble. Employers are often not very good at explaining what the role of occupational health actually is. They need to be explicit about what they are trying to do.”

She warns, however, that setting up a project like Health @ Work is a slow process.

“Our board of trustees represents all of the areas we work in, and if we do move into another area, we’ll seek out a representative for that area. Twice a year, we bring our stakeholders together and update them. We have been going for 15 years, but it is only in the last three or four that all of this has come together. It has taken us years to get this in place and it is very hard work to keep it all together. The trustees need to see how they benefit,” she says.

An interesting aspect common to a number of the network’s projects is that many clients are coming from organisations that already offer OH services. “Through the patient referral scheme, we identified that more than 50% were coming from larger bodies, including some really big employers, such as councils, which had their own OH service,” says Molloy.

Stress-related and musculoskeletal problems were the biggest issues faced by these clients, who included several patients from the same department of one organisation.

“There was clearly a problem there and we needed to offer them support,” she says. She is clear, however, that this support did not include trying to replicate the services that would have been available to these clients through their in-house OH provision.

“The project is not about medical intervention – what we are trying to suggest is that maybe they can revise their systems to be clearer to individuals about what is going to happen when they go to OH. The intention is not to undermine what OH is giving but to make them aware and support them,” she says.

Molloy says Health @ Work’s experience shows that smaller companies can often be quicker to deal with the problems of an individual employee than a larger organisation. “SMEs need people back quickly so they are often more likely to take advice and move things quickly. Local authorities, on the other hand, have long periods of sick pay, and if it is not managed properly, it can be a long time before an individual gets help,” she says.

“It is about being clear that the part of it is to support an effective return to work and address issues that might cause you to become ill again. If they are going back to work because they have run out of sick pay, the same things will happen all over again.”

Leeds OH Advisory Service

Empowerment is a concept that Steffan Harper, senior adviser at Leeds Occupational Health Advisory Service, is also keen on. “We attempt to empower people to deal with their employers,” he says.

This is particularly necessary when it comes to dealing with an increasing number of bullying cases. “More bullying is being brought to our attention, although whether there is actually more going on or not I don’t know,” he says.

“Employers are not very helpful in sorting these cases, says Harper. “The tendency is to whitewash. The level of co-operation we get depends largely on the degree of difficulty – employers are more willing to sort out the easier problems.”

The challenge for Leeds OHAS is tailoring its service to each individual case. “No two cases are the same. We have to adopt a personalised approach,” he says.

“We need to offer reassurance, advice and information. In 80-90% of stress cases, people are referred when they are already off work, and many don’t know their rights or what is available to them. They have absolutely no idea of health and safety law or employment law.”

An evaluation in 2003 has proved the value of the Leeds OHAS, showing evidence of significant workplace health and safety improvements, substantial sickness absence reductions and reductions in GP consultations. “Forty per cent actually made changes in the workplace and got back to work sooner,” says Harper. “We were surprised by the results.”

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