As thoughts turn to how the UK can gradually reopen for business post-lockdown, it is becoming all too clear that occupational health practitioners may find themselves facing massive practical, social, mental and physical health challenges within the workplace. So much so there are genuine fears the profession could end up completely overwhelmed. Nic Paton reports.
Employees reporting every day for at least four temperature checks. Constant anxiety. Mandatory masks in public. Meeting rooms reduced to a maximum of three people. Cafeteria tables partitioned off by vertical barriers. “Last disinfected” signs everywhere. Red, yellow or green “QR” codes on your phone to denote how at-risk you are of infection – and whether you’re OK therefore to travel on newly socially distanced public transport.
Such was the reality of “dystopian” life in Wuhan in late April and early May, as the original epicentre of the coronavirus pandemic cautiously began to reopen for business, according to an analysis by Bloomberg Business Week.
China and Chinese society is, of course, very different to our own. But the experience of Wuhan and other cities ahead of us on the pandemic “curve” may help to give at least something an insight into what the “new normal” looks like when we in the UK also emerge, blinking, into the post-lockdown daylight.
Just as importantly, it potentially gives us just a hint of some of the immense practical, social, mental and physical health challenges that occupational health practitioners working outside the NHS may find themselves facing as UK plc gradually, fearfully, reopens for business.
At the time of writing – early May – with the UK still in lockdown but a lot of focus and conversation now being given over to how restrictions might eventually be lifted, a few of these challenges are already beginning to become clear. Indeed, the government is this week due to be unveiling its plan for when and how we all get back to work. And the fear is, as we shall see, that the scale of the challenge will be such that occupational health provision, and practitioners, could be overwhelmed.
Massive mental health fallout
Much of the country has undergone a significant psychic shock over the past few months and mental and emotional health, fear and anxiety, are likely to be big, big issues as the economic cogs finally begin to turn again.
To cite just a few recent studies, research for the Mental Health Foundation found that even before the lockdown we were a nation gripped by fear, anxiety and a looming sense of panic. Almost nine out of ten employees also admit to having felt isolated, lonely and struggling with sleep during the pandemic crisis, a study by the jobs’ platform Totaljobs has suggested.
A poll by Opinium in April concluded that almost half (47%) of UK adults said their mental health had been affected by the coronavirus outbreak, with more than a third (35%) saying they were worried about their future, and the same proportion feeling “overwhelmed”.
There is a risk of a second overwhelming, and it won’t be the NHS front-line, it will be occupational health, and there are not enough of us, we know that
Perhaps unsurprisingly given the pressures they have been under, half of health professionals battling the virus also believed their mental health had deteriorated, with younger staff more likely to feel overwhelmed, according to the think-tank The Institute for Public Policy Research (IPPR).
“My worry is the psychological impact of this,” agrees one OH practitioner to Occupational Health & Wellbeing, who wished to remain anonymous. “Firstly the effects of being isolated and distancing and then the effects of people having to learn to work together again.
“I also think PTSD may be an issue, as this generation has not seen so many deaths in such a short period of time which has been so widely publicised. People have been running on adrenalin – what happens when that stops – are people going to crash? People are going to come out of this with real PTSD and it is difficult to get hold of proper trauma therapy as it is. NHS psychological services were already stretched before this – they are going to need a massive injection of funds to resource the fall-out from this.”
“In my clinics I have had a range of reactions, from extreme fear and avoidance of work (literally walking out and refusing to return) to those who do not perceive any risk and have not changed their behaviour,” says practitioner Stephanie Foster.
“A substantial number of people are reporting struggling with heightened anxiety, and it would be interesting to compare the reported numbers with reported numbers of people experiencing anxiety prior to Covid-19,” she adds.
With a vaccine at least a year away (and potentially longer), society is going to have to learn somehow to live with coronavirus. This may require a better understanding of the level of risk based on data, rather than perceptions, Foster contends.
“There isn’t going to be a quick fix to the Covid-19 virus. I’m interested in how we manage society’s and individuals’ perceptions in order to get people back to safe work,” says Foster, highlighting suggestions we may need to develop “Covid-secure offices”.
This could mean businesses being required to put up signs telling workers to remain two metres apart and instruct staff to go home if they have symptoms of Covid-19. It could also mean communal spaces such as canteens being closed unless people are able to socially distance and firms having to ensure they have a widespread supply of hand-washing facilities and hand gel.
Demand for workplace PPE
Within this, demand for, and access to, PPE within the workplace – and, importantly, whether it is necessary or even practical – may be another critical debate and pressure point for OH.
Independent specialist practitioner Sally-Anne Evans works with clients in education and manufacturing, and says she is already finding pressure building in this area – with OH often at the sharp end of dealing with requests from employers, unions and employees alike.
“In a school, for example, physical distancing is difficult and so, unless the present guidance changes – and it might – if teachers want to wear a mask I’m advising they should consider using an alternative homemade facial covering or perhaps making their own face shield so the children can still see their faces. If you start buying clinical masks for teachers, who don’t really need them, you are going to be stuck with that and will have to supply them for an unprescribed period; it would be very costly and potentially difficult to source, especially where they are needed in the NHS,” she points out.
There may be challenges around re-integrating teams where some have been furloughed and others haven’t, and there may need to be a sustained effort supporting workers who have suffered bereavement.
“I already know that some workers have lost relatives. Others too have had family in hospital, very ill. So there are issues around that, for example if they can’t come back to work because they are supporting people at home. There will be some bereavement/guilt present,” says Evans.
Challenges around health surveillance
How to carry out effective and safe health surveillance in this “new normal” may also be an issue. “Employers’ responsibilities towards employees’ health in terms of health surveillance have not ceased. The Health and Safety Executive has said paper screening should continue for now, any identified problems can be dealt with by telephone and then ordinary testing can continue after three months,” says Evans, adding that further guidance around what needs to happen after this period would be invaluable.
Requests for temperature-taking could be a further challenge, not least from a data protection/GDPR perspective, as such data will be classed as “special category”. There will be questions around how someone’s temperature is going to be taken, who is going to interpret it and how records are kept, Evans points out. “Someone has to be able to handle it properly; so that is probably going to land on the OH doorstep. There can be other reasons why someone might have a higher temperature that are nothing to do with Covid-19.”
Assuming at least some level of social distancing continues for the foreseeable future, there is likely to be a question-mark around how to carry out spirometry safely too, highlights Amanda Cairns, who runs Charlie Rose Occupational Health. SOM (the Society of Occupational Medicine) has published guidance around how to screen for HAVS remotely, but there may be much more like it needed in the longer term, she suggests. Similarly, what will be the health surveillance requirements around all the “emergency” PPE work now going on in non-specialist manufacturing settings?
“We have got people suddenly producing materials they have never produced. Where are the risk assessments for that? I look after a university and you’ve got people helping make visors. Is there any exposure there, I don’t know? Who is doing the risk assessments? Are these usual or other employees ‘just helping out’, I know it is a public emergency but at what point does it become, ‘this isn’t just a one-off, this has been going on for three weeks, three months, six months’?” argues Cairns.
For practitioner Anna Harrington, director of consultancy WHIB, occupational health may need to be leading on, and having conversations with employers about, a much wider and deeper mental health and wellbeing agenda post-pandemic, one that goes much further than just offering mental health first aid or access to EAPs.
“This is where the real cultural agenda needs to come into play, and it is about properly engaging with your employees to make those decisions, to look at ‘what is our team purpose, who is in our team, what are their roles and functions, what is it that identifies us as a group, how can we continue to recognise that we are a group together?’,” she suggests.
“What behaviours are not helpful? What sort of methods of interacting with each can we do that encourage those helpful behaviours? How do we look at the division of tasks and benefits of being part of that group?” Harrington adds, arguing we may need to see much more of a collaborative, partnership dynamic between OH and HR.
Risk of conflict and over-medicalisation
Within all the anxiety and fear, there may be an imperative for OH not to allow employers to over-medicalise things, emphasises Amanda Cairns. “We’ll have directors coming to us saying things like ‘we’re going to go out and procure a load of antibody tests, and we’re going to take everybody’s temperature, and we’re going to procure face masks that cost so much each’. And OH, rightly, will be advising, ‘well actually that’s not a good idea, for this, this and this reason’,” she says.
“But then the employer may just go off and do it anyway. So I think there is going to be a lot of managing conflict. On the one hand there is going to be a role for occupational health in reinforcing best practice guidance and, on the other, there is going to be this conflict resolution-type role where we’re caught in the middle of trying to negotiate both company-wide solutions and individual issues that will be medicalised very, very quickly because they are in the difficult category.
“Even though HR can look at the best practice guidance of when people should come back, when they have been social isolating, I think there are going to be issues where you have got individuals who are saying, ‘I’m self-isolating but I’m too frightened to come out from that’. The first thing HR will then do is refer to occupational health. But, actually, we may not be managing illness, we may be managing an issue that was there before, for example someone may have asked to work from home but have had the request declined; suddenly they have what they wanted and now they have to revert back,” Cairns points out.
Finally, given occupational health’s longstanding capacity issues – the fact it is such a small specialty and profession – there is a real worry that, once the immediate emergency of the pandemic is over, it could be occupational health that is on the health and wellbeing frontline and itself at risk of being overwhelmed.
As Sally-Anne Evans puts it: “In every single business sector there are workers, parents, carers – and all are going to be affected in some way. Any reason could stop them working, or stop them working well. If we don’t support people to work well and help business find its way through this, then it makes little difference that the economy is open.
“But also, my worry is what is going to hit us when this is all over? That is when occupational health is going to be right at the heart of it, and we need people to know about that before it happens. There is a risk of a second overwhelming, and it won’t be the NHS frontline, it will be occupational health, and there are not enough of us, we know that,” she adds.
Specific challenges of offshore
Aberdeen-based OH nurse practitioner Karen Hopkin specialises in working with the offshore oil and gas industry and highlights that there are likely to be major occupational health and wellbeing issues to work through post-pandemic. It is a worrying and challenging time for all in the industry, as well as the economics of redundancies because of the oil price crash, she highlights.
“Offshore workers are going to need occupational health support more than ever; there is an overriding challenge in helping employees to feel safe,” Karen points out.
“For example, oil and gas personnel at present receive a statutory two-year medical certificate. The Health and Safety Executive and Oil & Gas UK have extended current medicals that are about to expire until the end of June 2020, and we await advice on what will happen after this date.
“Medicals and fitness tests are normally seen face to face, post-Covid 19 how will this look? Will elements be eliminated; how much can be done remotely? As the UK’s oil capital, there are many companies in Aberdeen that rely on the offshore industry, and having these certificates in place. How will this be carried out safely is still being worked out,” she says.
Given the challenging logistics of the industry, there are ongoing issues around ensuring the qualified medic on each rig isn’t unavailable because of suspected Covid-19 and even simply the practicalities of getting personnel to and from the rigs and vessels.
“Currently the industry is flying helicopters with reduced numbers, sometimes reduced to core crew. But that’s expensive and cannot be sustained,” explains Hopkin. Even the practicality of physical distancing on a helicopter can be complicated. For example, in April a protective ‘snood’ face-covering was rolled out, among other protective arrangements.
Much like for Amanda Cairns, safe spirometry practice is likely to be a further issue. As Hopkin points out: “OH personnel will need advice around how to carry the medicals out safely. For example, will the spirometry element be removed temporarily?”
Finally, as we look to the autumn, there will be other more regular challenges coming over the horizon, but challenges nevertheless. “We’ll start ordering our flu vaccines in July or August,” Hopkin says. “With many hundred carried out, OH will need advice around arrangements and PPE.”
“Inside the Dystopian, Post-Lockdown World of Wuhan”, Bloomberg Business Week, April 2020, https://www.bloomberg.com/news/features/2020-04-23/wuhan-s-return-to-life-temperature-checks-and-constant-anxiety
“‘Covid-secure’ offices to get Britain back to work”, The Times, April 2020, https://www.thetimes.co.uk/article/covid-secure-offices-to-get-britain-back-to-work-amid-coronavirus-carnage-5d838fqxx
“Health and medical surveillance during the coronavirus outbreak”, Health and Safety Executive, https://www.hse.gov.uk/news/health-surveillance-coronavirus.htm
Cooke R and Lawson I (2020). “Remote assessment of hand arm vibration and carpal tunnel syndrome”, for SOM (Society of Occupational Medicine), https://www.som.org.uk/sites/som.org.uk/files/Remote_assessment_of_HAVS_CTS_final_SOM.pdf
Oil & Gas UK guidance, https://oilandgasuk.co.uk/wp-content/uploads/2020/03/OGUK-MEMBER-UPDATE-20-MARCH-2020’.pdf
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