Bridging the gap

the OH team at the Leicestershire Fire and Rescue Service deals with the
challenge of offering a competent OH service to such a diverse clientele, by
Sara Bean

As the recent firefighters’ dispute demonstrates, despite the current trend for
giving managers ample opportunities to improve their people management skills,
there is often a huge gap between employers and employees.

In many cases, this gap is not manifested in national pay disputes but
instead, stressed employees feeling they can no longer cope with their jobs,
leading to increasingly high absence rates.

A recent report by the HSC showed that although death rates from accidents
at work are falling, more people than ever are taking sick leave, which they
blame on workplace factors.1

Addressing the communication problems between employer and employee over
work-related health issues is an important role for OH. And it is a role that
the OH team at Leicester Fire and Rescue Service occupational health unit

Gail Cotton, head of OH at Leicestershire Fire and Rescue Service OH unit,
believes OH’s role often involves bridging the gap between employer and
employee to help resolve workplace health problems.

"A lot of managers don’t manage well," she says. "As the
workplace changes to more people-focused than a process-driven environment,
often managers are not equipped with the people skills to manage. If you are
not a people person, you could get it wrong. We are increasingly assisting and
advising managers on people management."

In an innovative scheme, Leicestershire Fire and Rescue Service has expanded
its occupational health unit, enabling it to offer OH services to local
businesses, which in turn fund improvements to the level of healthcare it can
offer to its 850 fire and rescue staff.

The unit now manages the health of some 20,000 local council employees, a
local bus company, probation services and a plethora of small and medium-sized
enterprises (SMEs). The unit has set up service level agreements with SMEs,
which pay for the service as they use it, and they now account for about a
quarter of the unit’s business.

Cotton says: "We’re not charging vast sums to SMEs, but we are income
generating, and the recent extension to our building is a benefit of the work
we have done. Our reputation is spreading through marketing, acknowledgement
from the local HSE office and positive word-of-mouth."

The team, which comprises a number of OH nurses, an OH manager,
administrators and OH physicians, offers a wide range of services, including
workstation assessments, referrals, pre-employment checks, rehabilitation, and
an advisory service to managers and clients on the many issues pertaining to
health at work. Counsellors and physiotherapists also hold clinics at the unit.

Cotton adds: "Someone might come in with an upper limb disorder, and
will need to see a nurse specialist, or it may be that a stressed employee will
benefit from seeing a counsellor. We like to think of this unit as a ‘workplace
health centre’. We run three or four clinics a day."

There is real diversity in the occupations covered by the unit. For example,
among the council staff are teachers, magistrates, road workers, drivers and
environmental health officers, and, of course, there are the firefighters.

Firefighters’ OH needs

Specialist practitioner Anthea Turnbull’s main area of responsibility is the

She explains that all fire recruits have basic pre-employment surveillance,
covering vision, lung function, hearing, a physical assessment and a step test.

Once they have joined the service, firefighters do not require a medical
unless they are injured or aged over 40, which, until the introduction of the
new and improved OH service could cause problems, explains Turnbull.

"In the fire service, anyone over 40 must have a medical. In the past,
many waited until that milestone to see us, worried, for example, that a back
problem may mean they were not fit for duty.

"However, by not having a problem addressed straight away, it may have
been too late to treat properly, and the condition could have been much worse.
Now that they are more likely to get a problem sorted earlier, we are in a
position to enable them to do their jobs, so they are more likely to see us as
a force that’s there to help," she says.

As a result, the OH service has seen a 70 per cent increase in enquires
since it introduced a physiotherapy clinic. It is the same with vision,
explains Turnbull.

The cost of funding a firefighter with two pairs of specialist glasses is
much less than retiring them on health grounds, and the new ‘aids to vision’
policy within the fire service has made a big difference.

A great deal of OH’s success with the firefighters has been through
word-of-mouth. For example, station officers who previously may have kept
workplace health problems within the team, are now more confident about getting
in touch with OH about any queries or problems their staff are experiencing.

Turnbull also has responsibility for a range of other clients. She says:
"As well as looking after firefighters, I’m responsible for other small
businesses, including warehousing, a pet food manufacturer, retail, local
probation services and offices. In fact, what I love about this job is that it
is so broad, it is incredible."

Dealing with long-term sickness

The OH team agrees that one of the greatest challenges for the unit,
especially when taking on a new contract, is dealing with problems created by
long-term sickness absence.

Cotton describes the pattern of long-term sickness absence as the following:

– Employee is worn out

– Takes sick leave – self-certification

– After two weeks, sees GP – is signed off

– Feels worse, goes back and sees GP, now four weeks off

– Proscribed anti-depressants, which take four to six weeks to work

– Now off work three months with no solution being offered to help deal with
the underlying problem.

And worryingly, she says: "A lot of people who are referred to us have
had no contact from their managers, sometimes at their own request, so there
needs to be a mechanism in place to keep contact open."

OH physician Dr Roger Calvert agrees. He explains that many clients he sees
have been off sick for a while, and are referred to him once their sick pay
goes down to half pay or statutory pay, after three or six months.

By this stage, employers will want to know whether their sick staff will
ever return to work. A high proportion of the people he sees are suffering from
psychological ill health, and some do have depression or anxiety disorders that
can be related to the workplace.

He says: "It could be a relationship problem or changes to how the
workplace is organised. Often, something has happened to change the processes
in their job, and we may need to explain to their managers that it is all down
to the management of change to help them cope."

By putting procedures in place to address the problem of sickness absence
early, and intervening to help encourage those already on long-term leave to
seek help, the OH team has already helped get clients back to work.

Teresa Harrison, a senior specialist nurse with the Leicestershire OH unit,
has lead responsibility for the county council contract, and includes a local
bus company among her portfolio.

"The bus company is a particularly challenging contract. OH is a new
concept to it, but it is willing to develop and happy to utilise our
rehabilitation services. It is keen to phase people back into work, and we have
already had some success. We have just got someone back to work on a
slow-phased return, following a two-year absence."

Diversity of OH service

All of the team at Leicestershire Fire and Rescue OH unit agree that one of
the best aspects of the job is the diversity of occupations within their remit.

Helen Caple, an experienced OHN who works part-time for the unit, says:
"I enjoy this job because you do a wide range of different jobs and deal
with an interesting and diverse range of people."

She explains that although the usual OH problems such as musculoskeletal
disorders and work-related stress could be applied to many occupations, certain
job roles have their own distinctive hazards.

For drivers with the local bus company, the two greatest occupational
hazards are back problems from driving and, occasionally, stress-related
problems from having to deal with abusive passengers.

Some of the manual jobs within the team’s portfolio have their own
particular hazards, from musculoskeletal problems experienced by road workers
carrying out heavy manual work, to the danger of breathing in fumes among
street surfacers.

When the contract for managing the 20,000 staff at the county council was
won, the OH unit helped establish a user group to discuss the different needs
of such a diverse client base.

This helped to determine the specific issues needed to help people with
particular workplace health needs – whether it was the need to carry out
surveillance for certain occupations, for example, ensuring drivers for the
library vans comply with DVLA standards, to helping manage the problems of
stress experienced by some of the teachers in the county.

Cotton says: "We found that teachers in particular were often absent
from work for three months before they were referred, so we are trying to get a
process of early intervention in place to prevent this happening in the

Role of the OH nurse

So in their role as a bridge between employers and their employees, do the
occupational health practitioners at Leicestershire Fire and Rescue OH unit require
more in the way of good management skills rather than a nursing background?

Anne Fordham, a practice nurse who has worked in OH for just 18 months,
thinks a nursing perspective is an essential part of the service the team

She says: "I think you need a nurse’s understanding of what people need
when they come to you with workplace health issues. And in a practical sense,
it helps to understand their medical background.

"I had a client who recently had heart surgery and though pronounced
fit, was nervous about returning to work. As a nurse, I understood the reality
of what happens when you undergo such a serious operation, something that
perhaps a non-medical manager would not understand."

Fordham was concerned that by moving into OH she would lose contact with
people, the area of nursing that she most enjoys, but has been pleasantly
surprised that dealing with people is such an integral part of this job.

"It is about developing people to help get them back to work, and when
people keep in contact after a successful return to work, I know we have done a
good job," she adds.


1. HSC Health and safety statistics highlights 2001/02


Leicestershire Fire and Rescue Service OH Unit, telephone: 0116 2203232

The OH team at Leicestershire Fire and Rescue Service

The OH team at Leicestershire Fire and Rescue Service comprises:

Head of OH – Gail Cotton

Specialist practitioner -Anthea Turnbull

Senior specialist nurse -Teresa Harrison

Practice nurse – Anne Fordham

Part-time OHN – Helen Caple

Clinical/clerical/healthcare assistant – Susan Vincent

Administrators – Elaine Haseldine, Jo Trahearn, Anna

OH physicians – Dr Roger Calvert, Dr Adele Beckley, Dr
Jim Smeeton

Principal services offered:

– Assistance with risk management

– Audiometry (hearing assessment)

– Clinical/medical appointments

– Consultancy – OH advice on work and health

– Drivers’ screening

– Health assessments

– OH telephone advice

– On-site OH programmes

– Pre-employment health screening

– Respiratory surveillance

– Well person screening

– Workstation surveillance

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