Home-made healthcare

How do you provide healthcare to 21,000 staff spread over 70 UK sites? If
you’re Rank Hovis MacDougall you establish a nationwide network of home-based
advisers.  By Kate Rouy

An office above a Windsor shopping centre hardly seems a likely meeting
place for the average occupational health team, especially one representing one
of the UK’s largest food manufacturers. But for the occupational health and
safety advisers at Rank Hovis MacDougall (RHM), this gathering represents one
of the few chances of the year to get together with colleagues who are spread
from the South West of England to North Scotland.

RHM is one of the longest established food manufacturing companies in the
UK, with interests in milling and baking including Mr Kipling cakes, Bisto,
Sharwoods, Robertsons jam, Hovis and Mother’s Pride, Saxo and Paxo to name but
a few. It also manufactures own-brand products for most of the major
supermarket chains, including Waitrose, Tesco, Asda, Morrisons, Sainsbury’s and
Marks & Spencer, as well as pizza bases for Pizza Hut and burger buns for

The company has 21,000 employees, based at 70 sites across the UK,
potentially a logistical nightmare for occupational health provision.

Blanket coverage

The solution is a network of regional medical and nursing advisers, based at
home, who provide blanket coverage of every site, with a new tailor made IT
system allowing every member of the team to keep in daily contact.

According to group medical adviser Dr Trevor Smith, such a system is the
only way to operate effectively, given the nature of the RHM business.

"Everyone works from home, the reason being because a typical RHM
production site, with between 300 and 400 people does not have a requirement to
have a full-time service."

Health provision began at the company in 1960 at the instigation of the
then-chairman Lord Rank, and according to Smith, "the same reasons to work
from home hold good now as they did then. With a small number of people on-site,
this is the best way of providing them with a professional service."

Numbers on-site vary from a typical bread bakery with 300 workers that would
receive a visit from a nursing adviser once a week, to a flour mill employing
25 people that would be visited every two months.

The team is divided between North and South, with Birmingham and the East
Midlands as the dividing line. Smith and medical adviser Dr Seema Sawhney
operates in the South, with Dr Trevor Parker and Dr Tokeer Hussain responsible
for the North. The Windsor base is the only office the occupational health
service has, and is home for the administration staff. Otherwise, says Dr
Smith, "we work from company premises, first aid rooms or offices."

Traditional industry

With baking and milling remaining intrinsically a traditional industry, the
health team are called upon to confront a number of health issues, from
respiratory problems, work related skin conditions and manual handling issues
to repetitive strain injury. Employees include food handlers, drivers, and cold
store workers as well as office based workers. Nursing advisers also often have
to cope with language problems, with many manual workers especially in the
heavily urbanised areas speaking little or no English.

In addition, says Smith, all nursing advisers are trained in the art of
stress management.

"Stress is a major part of sickness absence and we are speaking to
managers, making them aware of the risks and giving them an action plan to go
forward and reduce it."

A stress surveillance data base was initiated in September last year, the
results of which are yet to be analysed, and in addition the team undertake as
much health promotion work as they are able to.

Research and health surveillance forms are an important part of the health
service’s work, especially in the field of respiratory disorders in relation to
exposure to flour and ingredient dust, and it works closely with industry
bodies like the Health and Safety Commission.

"Our findings were presented to the Health and Safety Commission’s
regulatory committee which has been looking at the exposure limits for flour
dust," says Smith.

"We have also recently completed research on skin conditions and we are
expecting publication as a result.

Nursing adviser Joe Patton, who is based in the West Midlands, has also been
involved in a programme targeting muscular skeletal conditions.

"We have reduced musculoskeletal injuries to well below the national
norm for the food and drink industry, from 33 per cent to 22 per cent over
three years," he says.

The RHM service has also had a large input, with the Federation of Bakers,
in the development of a training programme for the baking industry in relation
to dust and respiratory problems, with the production of a video, "Breathe
Easy" demonstrating the hazards of breathing flour dust and encouraging
workers to take a more proactive approach to health at work.

By adopting such a behavioural approach, says Patton, "people are able
to control their own destiny. Using the video and a questionnaire which tests
knowledge about training in several sites we have been able to improve working
practices. That way we are trying to educate the workers, to get them to
understand the risks to their health," he says.

He adds that the company is taking a similar approach with lifting, hearing
and other issues. "We want to make people aware of the measures they can
take to avoid risks to their health."

Safety and hygiene

Safety and hygiene advisers are also involved in a number of on site
surveillance programmes, and encourage workers to voice their opinions.

"We have introduced a behavioural safety programme devised to assess
the safety management system, based on a no blame culture," says safety
and hygiene adviser Graham Taylor-Grout.

"The operatives get to have their say on discussing health and safety
with the emphasis on no blame, aimed at reducing accident statistics. And we
have started to see some real improvements.

"We also undertake site performance audits every year, with the results
used as a financial incentive for the business to improve its
performance," he says. "This has come from us rather than from the
business and is something that we have done for them."

The computerised system used by all the team was introduced at the end of
last year, designed specifically for RHM needs.

"It enables all the advisers to communicate via e-mail, receive and
distribute information and maintain contact," says Dr Gordon Parker.
"We all have laptops and everyone is updated on a daily basis. And in this
way we have been able to address one of the major disadvantages of working from
home. Professional isolation has been counteracted by good communication.

Mary Mercer covers RHM sites in Scotland. Based in Glasgow, she spends a lot
of time on the road, but agrees that working with a home base works very well,
especially since the introduction of the new system.

"I find e-mail easier than the phone," she says. Isolation is not
a problem, she says, neither is a low OH profile on-site.

"I can be on-site for four or five days a week," she says.
"All our equipment is transportable and managers always know where we are.
I think this is an enviable job. There is something quite nice about being at a
different site every day, and this is the most varied job I have done."

While she says that health promotion work can sometimes prove difficult
without a permanent base, she says the advantages far outweigh the

"We are all accountable for our decisions, and we are very much
managers and advisers. We do have quite a high profile."

Odd one out

Sue Rocke is unique among the team as the only nurse adviser based on-site,
at a bread bakery at Erith, Kent. She works two days a week, studies for her OH
degree at the RCN for one day a week, and feels she has the best of both

"This is my first OH role, and I do feel quite isolated at times, but
there is always someone there if needed. And one of the advantages of being
on-site is that the people here do feel that I belong to them."

Overall, Smith feels the team, despite its geographic disparity, works well
together. "Occupational health has a good position within the company and
it is well established, and that has been the principle right from the start.
We regard our role as helping the business to perform well in terms of its
activities, but also to optimise its financial performance. Overall within the
RHM Group we have helped over the last five years to reduce employers liability
by about £1m."

However, he says, there is no room for complacency. "We are continually
having to justify ourselves," he says.

"We have to demonstrate that we add value to the business. We are very
professional, very well qualified, we know the business well and we provide
national coverage. But we must continually demonstrate that an in-house service
has benefits over a contracted service."

Rank Hovis MacDougal health service team factfile

The Rank Hovis MacDougal team includes:

Trevor Smith                group medical adviser
Barbara Harrison          group safety and
hygiene manager
Gordon Parker             senior medical adviser
Seema Sawhney           medical adviser
Tokeer Hussain            medical adviser
Louise Briggs                nursing adviser
Jennie Edwards            nursing adviser
Jackie Jose                   nursing adviser
Pat Laithwaite               nursing adviser
Cathy Laycock             nursing adviser
Maureen Lunt               nursing adviser
Mary Mercer                nursing adviser
Julie Metcalfe               nursing adviser
Joe Patton                    nursing adviser
Sue Rocke                   nursing adviser
Gill Smith                      nursing adviser
Irene Stephen               nursing adviser
Pauline Wastell-Smith   nursing adviser
Pamela Ferguson          safety and
hygiene adviser
Tim Gassick                 safety and hygiene adviser
Steve Kay                    safety and hygiene adviser
Lee Knowles                safety and hygiene adviser
Mandy Lewin               safety and hygiene adviser
Graham Taylor-Grout   safety and hygiene
Graeme Westland         safety and hygiene

Number of employees responsible for 21,000 based at 70 sites across
the UK

– Reduced musculoskeletal injuries to below the norm for the food and drink
industry – from 33 per cent to 22 per cent over three years

– Developed a training programme and video for the baking industry on dust
and respiratory problems

– Introduced a behavioural safety programme

– Site performance audits introduced annually

– Reduced RHM’s employer liability by about £1m over five years

Goals To demonstrate that the occupational health team adds value to
the business and that an in-house service has benefits over a contracted

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