Dan Gillard, head of the occupational health and wellbeing service across the police and fire services in Surrey and Sussex, explains how they monitor health and wellbeing among workers in safety-critical and high-pressured environments.
In 2018, Surrey Police, Sussex Police, Surrey Fire and Rescue and East Sussex Fire and Rescue Services entered into an agreement to expand the existing occupational health collaboration that covered the two police forces to include fire and rescue services.
The four blue light services developed a structure that would drive quality and efficiency, ensure clinical governance, enable the parties to meet their statutory duties, and ameliorate the impact of reduced budgets.
Emergency services OH
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A new OH and wellbeing service (OHWS) was established. Staff are employed by the various services and seconded to the shared OHWS.
The team is nurse led: the clinical lead is supported by two senior OH nurse advisers (OHNAs) and five OHNAs. There are also two screening nurses – one of whom is currently completing a degree in OH nursing – two occupational health technicians, and a personal assistant for the head of service.
Occupational medicine advice is split between an in-house physician and a third party, making one full-time equivalent. The reason for this split is to ensure good resilience and avoid a single point of failure.
Some of the OHNAs work remotely while others work in a hybrid way. They have flexible working hours, enabling them to fulfil their family and other responsibilities outside of their jobs.
The OHWS team also has a manager responsible for assessing ill health retirement (IHR). This enables a smooth flow of OH and medical records required for IHR assessments and any possible injury on duty financial awards.
Additionally there is a wellbeing team encompassing a wellbeing consultant with an HR background, a wellbeing lead with a recruitment background, a multifaith chaplain and a wellbeing screening practitioner with a background in health education. The wellbeing screening practitioner has visited 241 sites across the two counties, undertaking mini ‘MOT’ health assessments and health promotion initiatives. We will be extending this to support the NHS blood pressure campaign by offering every employee a blood pressure check. Wellbeing is a natural fit under, or very closely aligned, with OH.
There are standards and knowledge required to be on a nursing or medical register and the employer has a duty of care to employees that information or programmes related to health and wellbeing must be evidence-based and delivered professionally. Oversight from a registered health professional can ensure that good governance and quality of service are in place (Miller, 2022).
Psychological hazards
Health and safety legislation requires “health surveillance when your workers remain exposed to health risks even after you have put controls in place. This is because control measures may not always be reliable” (HSE, undated). A legal basis is required for processing data (NHS Research Authority, undated) to justify why health information is being collected.
An individual’s job description and a risk assessment are used to identify the known or possible hazards they will face and whether statutory health surveillance is required. Additional medical surveillance is undertaken by an OH physician if the worker could be exposed to chemical or physical hazards such as asbestos and ionising radiation. Obtaining all the information we need requires a close working relationship with line managers and health and safety departments.
The principles of risk management are to remove the hazard first, but if it cannot be removed then it must be reduced. In policing and fire and rescue work, the psychological stressors cannot be removed, so we must undertake psychological health surveillance.
For police roles we use a specialist third-party provider with a well-established process for assessment. There are nine roles within policing considered to be at high risk of psychological stress and a handful within fire and rescue.
In policing and fire and rescue work, the psychological stressors cannot be removed so we must undertake psychological health surveillance.”
Those whose role has the potential to expose them to psychological stress complete an online assessment. This includes questions about the worker’s psychological history, coping skills and any current symptoms or significant stressors. Individuals who score highly on this assessment are offered a follow-up appointment with a clinician who has had additional training. This monitoring and assessment structure aims to identify individuals who will require treatment for psychological symptoms.
The psychological stress in emergency services cannot be removed, therefore we have a responsibility to reduce workers’ exposure to triggers where possible. Line managers can adjust the working day, but depending on the role this is not always possible due to the demands on policing and the fire service.
A system to measure exposure for response officers and CID, called ‘Trauma Tracker’, is in place. Employees who have been exposed to trauma are required to have a conversation with their line manager, who logs the significant incidents. Once a certain point has been reached the need for support is triggered.
Managers have the option of arranging sessions with organisational ‘diffusers’ – firefighters, officers or team members who have been trained to help with trauma. This role is in addition to their normal duties. Firefighters, police officers and staff also have 24-hour access to a counselling service, volunteer multifaith chaplains, mental health first aiders, and may also be referred to OH.
Resilience
Individuals are less likely to suffer psychological stress if they are resilient. The main factors affecting resilience are other stressors in life, and vary from person to person. Resilience is concerned with individual variations in response to risk (Rutter, 1987). Some individuals become overwhelmed by the continuous stressors associated with the work of the emergency services, while others respond well to the challenges their job presents.
Resilience is developed by training, experience, and support. The better prepared and the more knowledgeable staff are regarding what to expect in their role and the likely outcomes of interactions with the public, the more likely they will be able to cope with workplace stressors. With experience, they develop the knowledge and skills that increase their options for positive outcomes.
Initiating support is the responsibility of both the individual and their manager. The training, learning and professional development department is responsible for training managers; the individual is responsible for seeking support; and OH is responsible for ensuring that support mechanisms are accessible, relevant, evidence-based and governed appropriately.
Pre-placement and periodical assessments
The roles with the highest risk of psychological stress have pre-placement and periodic psychological assessments, but it is very unusual to refuse employment on the grounds of what may happen to their health.
To enable a full and fair assessment of the applicant, a panel comprising senior operational personnel, recruitment, OH, HR, and any other relevant parties, review the advice from OH and consider this against the possible risks and if possible, develop a strategy to protect the health and wellbeing of the applicant. They must weigh this against the risks to the public if the applicant is restricted in what they can do. If they are unable to make adjustments to accommodate the applicant, the employment can be refused.
The roles with the highest risk of psychological stress have pre-placement and periodic psychological assessments, but it is very unusual to refuse employment on the grounds of what may happen to their health.”
Firefighters and police officers face significant physical demands and hazard exposure, so it is important they are physically fit to perform. Those who face possible exposure to chemical, biological, radiation and nuclear materials may require pulmonary function testing depending upon the personal protective equipment, including breathing apparatus, they require for specific incidents. This is a complete evaluation of the respiratory system, including patient history, physical examinations, and function testing. This helps identify any pulmonary impairment and have a baseline from which to base assessment before any exposure.
Policing pre-employment medicals must include an eyesight check, including for any colour deficiencies, and tests for other measurements such as blood pressure.
In addition to the pre-employment medical, periodical medicals are required for a range of specialist policing roles, particularly those considered safety-critical. Individuals who are physically unable to perform a role due to a known health condition or physical limitation, or whose health condition will place them or others at risk, are likely to be excluded from that role either temporarily or permanently.
The OH clinical team will sometimes assess individuals with a health condition, such as very high blood pressure, which would likely put them or others at risk. The OH clinician must explain the finding to the individual, advising them and their manager that they are not to return to that safety-critical role until the decision is cleared by OH.
Physical hazards
Policing roles that requiring health surveillance include those working with dogs or horses (hazards include respiratory sensitisers, noise, and skin); firearms (noise); and vibrating machinery such as vehicle maintenance, motorcycle riders and helicopters (noise and vibration).
Roles that may expose individuals to chemicals are firefighters, crime scene investigators including fire investigators, and the chemical, biological, radiological and nuclear (CBRN) team. The safety measures for reducing exposure for the CBRN team range from a paper mask, a respirator with a changeable canister to filter the air, and a fully self-contained breathing apparatus. There are six different types of PPE suits for CBRN work and other specialist varieties for firefighters.
Some of the breathing apparatus requires a seal around the face and the individual must be clean shaven where that seal meets the skin.”
Some of the breathing apparatus requires a seal around the face and the individual must be clean shaven where that seal meets the skin. This must be tested with a test kit, such as the Moldex Fit Test Kit, to ensure correct fitting. The individual must also have sufficient lung capacity.
The role of OH
There are a wide variety of physical and psychological hazards associated with policing and firefighters’ roles. The nature of the emergency services means removing hazards is not possible and, in many cases, even reducing the hazard or exposure is not likely.
OH has an extensive role in the employment and specialist selection processes, periodic assessments, health surveillance and fitness assessments for specialist posts, supporting training, and management referrals to advise on adjustments.
Occupational health is an integral part of the emergency services. Their role supports the health and wellbeing of service personnel, enabling the employer to comply with their legal and moral duties.
The professionalism that comes with having a team of suitably qualified OH specialists that understand the work of firefighters and police officers and have developed strategies that promote their health and wellbeing supports the frontline functioning of the organisation.
References:
Health and Safety Executive (undated) Health surveillance – Understand what type your business needs
Miller, J. (2022) The Policing Mind: Developing Trauma Resilience for a New Era. Bristol University Press. pg. 184
NHS Research Authority (undated). Legal basis for processing data
Rutter, M. (1987). Psychosocial resilience and protective mechanisms. American Journal of Orthopsychiatry, 57, 316-331
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