When an SME turned to the NHS to help it overcome the delay in renewing drivers’ licences, health promotion was the answer. Sandra Adams explains.
Among the targets set by the Health and Safety Commission in 2001 to improve health at work by 2010 was the use of the workplace to promote the health of employees. Prior to this, the same ethos had been outlined in 1998 by the English National Board and the Department of Health in the publication Occupational Health Nursing, Contributing to Healthier Workplaces.
The government repeated the message in the Choosing HealthWhite Paper, suggesting that the workplace is an ideal platform to enable and support health by encouraging employers to promote health and support their employees in making healthier choices.
However, it is vital to the success of any health promotion programme to have the support and commitment of the company. This is particularly important when considering when, where and how the programme will be delivered to enable the workforce to participate fully the company needs to balance the benefits of the intervention with the cost of workforce members being allowed to participate during work time, the cost of any training required by the OH nurse, and the cost of providing the service.
I work as a specialist nurse in an NHS occupational health department that is part of NHS Plus, offering OH services to local small- and medium-sized businesses.
This article looks at how health promotion was provided to a local transport services company, which employs 150 drivers who were required to have passenger carrying vehicle (PCV) licences.
The company asked for our help to set up and develop on-site well-person screening, incorporating health promotion, as an annual event for all drivers.
The company’s aim was for the service to help maintain or improve the health of their drivers so that the drivers would have fewer health problems when it came to renewing their PCV licences. This would then help prevent delays caused by their temporary licences being revoked because they did not meet the Driver and Vehicle Licensing Agency (DVLA) standards of fitness for Group 2 licences (see figure 1).
It was also hoped that this would help reduce sickness absence by giving on-site access to a health professional for advice and signposting to other agencies as appropriate.
A system of annual well-person assessments was introduced after negotiation with trade unions. Collaboration took place between the company and OH as to what was included in the assessment – for example, the company wanted annual vision screening performed, demonstrating good practice as an employer of people who drive for work, as advocated by the Royal Society for the Prevention of Accidents.
It was agreed that Keystone vision screening would be performed as part of the assessment. If any problems were identified during the screening, the driver would be advised to seek advice and further testing by a qualified optician.
Other areas included in the assessment were questions regarding family history of serious disease (for example, heart disease, diabetes, cancer), medication taken, lifestyle issues such as alcohol consumption, smoking habits, exercise taken, diet, musculoskeletal problems, urinary and/or gynaecological issues, perceived stress, and hours worked, including overtime. The session also included a blood pressure (BP) check, and height, weight and body mass index (BMI) measurement.
The session concluded with some health promotion about any particular issues identified by the nurse referral to the GP for any issues requiring medical intervention or referral to the occupational health physician, particularly with regard to the DVLA standards of fitness for driving a PCV. The OH department also provides licence renewal medicals, pre-employment health assessments, manager referral consultation, and annual health surveillance for the garage/workshop staff.
The scheme started in April 2004. Initially there was some suspicion from the staff of the company’s motive for offering the scheme and also about the confidentiality of the information given.
With the trade union officials already agreeing to the programme, they were offered some of the first appointments. This allayed some of the worries, and time was made available in each session to try and allay these worries further and re-iterate the importance of confidentiality and how this was being provided. Despite the initial reluctance of some to attend the appointments, three years on some drivers are actually requesting an appointment.
The Acheson report shows that health and disease are affected by social classification. The more affluent members of society live longer and more healthy lives than the more disadvantaged social groups, with most disease categories more common among social classes IV and V (where class I are professionals and class V are unskilled manual workers).
Naidoo and Wills suggest this may be attributed to the high consumption of tobacco, fatty and refined foods and alcohol, along with a lack of exercise in the lower social classes. The drivers in this scheme would appear to belong to class III/IV. However, it must also be considered that they have a shift pattern of work which can make access to health services, such as dietary advice and blood pressure monitoring by the practice nurse, more difficult, with the busiest times of their workload being during ‘normal’ working hours. They also work very early mornings and late evenings, and split shifts. Their job, by its very nature, is sedentary, and the drivers feel their shift patterns and hours of work give them little opportunity to carry out any form of exercise.
One of the main focuses of the appointment was to look at health issues that would affect PCV licence renewal. Fifty-six per cent of the workforce are over the age of 45, which means they are required to renew their PCV licence on a five-yearly basis and therefore pass a medical examination with a physician acting under strict DVLA guidelines. Developing any one of number of diseases, such as uncontrolled hypertension, angina and heart disease, can lead to refusal or revocation of a Group 2 licence, at least temporarily, causing possible long-term sickness absence or potential loss of employment. After the first year of assessment, a picture of the health of the workforce emerged (see figure 2 below).
Following the specific concerns of the company with regard to its workforce, it was decided to continue to focus on BMI over 30kg/m2, raised BP and smoking in the subsequent two years. A combination of one or more of these risk factors further increases the risk of developing heart disease figure 3 shows the figures collated from the first year of assessment.
More focused health promotion was offered to individuals showing signs of any of these risk factors, including dietary advice, information regarding local smoking cessation groups, and referral to their GP for treatment of high blood pressure. Advice, or signposting to other services, was also offered regarding ways to increase exercise levels, moderate alcohol intake, manage vision problems and any other areas the drivers perceived as being a health problem.
One of the benefits of this was to discover at an early stage health problems that may impact on their fitness to retain a PCV licence, so these problems could then be addressed and treated before the DVLA medical and before the issue resulted in sickness absence.
Figures were collated annually and presented to management – no personal identifying information was included – and to the workforce in the form of a poster display.
After three years of work with the company, those with a combination of three risk factors of a BMI over 30kg/m3, high BP and being a smoker had dropped those with two factors had also dropped, those with one factor had risen, and 36.3% now displayed none of the three risk factors. The company has declared that sickness absence at this depot is now the lowest of the group, and has asked the OH department to expand the service to cover all of its depots in the Northern region, allowing us to consider further development of the department in terms of recruitment and training.
Figure 1: Medical requirements for DVLA Group 2 (including PCV) licence holders
Group 2 licences include large lorries and buses. DVLA states: “The medical standards for Group 2 drivers are very much higher than those for Group 1 because of the size and weight of the vehicle. This also reflects the higher risk caused by the length of time the driver may spend at the wheel in the course of his/her occupation.”
Age limits – issued at age 21 and valid until 45, thereafter renewable every five years until age 65 and then annually.
Specific disorders – including neurological, cardiovascular, psychiatric, visual, renal and respiratory disorders as well as diabetes and drug and alcohol misuse and dependency. The following conditions are a bar to holding a Group 2 licence:
Epilepsy – a diagnosis of epilepsy requires 10 years free of attack without anti-epileptic medication.
Diabetes – insulin-treated diabetics cannot obtain a PCV licence.
Eyesight – drivers must have visual acuity of at least 6/9 in the better eye and 6/12 in the worse eye. If this is achieved by wearing corrective lenses, the uncorrected visual acuity in each eye must be no less than 3/60. Normal binocular vision must be demonstrated. Monocular vision bars holding a Group 2 licence as does uncontrolled symptoms of double vision.
Hypertension – where the blood pressure is consistently higher than 180/100.
More condition-specific information is available from the DVLA website.
Figure 2: Health profile of driver workforce
Figure 3: Percentage at risk of developing heart disease
High risk – have a BMI of over 30, raised blood pressure and are a smoker
Medium risk – two of the above risk factors
Low risk – one of the above risk factors
None – none of the above risk factors
Sandra Adams is an occupational health nurse working for NHS Plus
Health and Safety Commission (2001). Securing Health Together. Health and Safety Executive.
English National Board for Nursing, Midwifery and Health Visiting and the DOH (1998). Occupational Health Nursing, Contributing to Healthier Workplaces. English National Board for Nursing, Midwifery and Health Visiting and the DOH, London.
DOH (2004). Choosing Health: Making Healthier Choices Easier. DOH, London.
DVLA (2007). At a glance guide to the current medical standards of fitness to drive – A guide for medical practitioners. Available from: www.dvla.gov.uk/at_a_glance.htm.
ROSPA (2005). Eyesight and Driving. Available from: www.rospa.com/drivertraining/factsheets/eyesight.htm.
Acheson, D (1998). Independent Inquiry into Inequalities in Health. London.
Naidoo, J and Wills, J (2000). Health Promotion – Foundations for Practice. 2nd Edition. Bailliere Tindall.
British Heart Foundation (2007) Statistics Database. Available from: www.heartstats.org
Nursing and Midwifery Council (2004). Code of Professional Conduct. Nursing and Midwifery Council, London.