When builder Robert Cowley suffered severe head and spinal injuries falling 10 feet from a ladder while working on a construction site in northern France in October 1999, he was initially offered just 18,000 compensation.
But in April this year, Cowley, 47, who had at the time been working for a Bedford-based building contractor called Irvine Whitlock Ltd, was awarded a six-figure settlement known to be worth considerably more than 125,000.
There are a number of factors in this story that should not surprise OH professionals considering musculoskeletal disorders (MSDs) and injuries.
First, the fact that the injury occurred on a construction site. Even with the Health & Safety Executive (HSE) now regularly ‘blitzing’ construction sites and plans continuing to create an OH service for the industry, the sector remains a singularly poor performer when it comes to injuries, musculoskeletal or otherwise.
Latest figures from the HSE found that more than half of workplace fatalities occurred in just two industries: construction and agriculture.
The second, and equally important, factor is that Cowley’s plight, at least initially, was not taken seriously enough by his employer. According to the HSE – which is currently running a major campaign over bad backs – MSDs are still the most common occupational illness in the UK, affecting 1.1 million people a year and costing society £5.7bn.
MSDs have been the subject of decades of healthcare research and good practice, yet all this work and effort have hardly altered the figures for MSDs at all.
In June, the HSE estimated that UK business lost an estimated 4.9 million days to employee absenteeism through work-related back conditions each year.
Each affected employee took an average of 19 days off work, it added, using an analysis from the latest official 2003/4 Labour Force Survey.
The charity BackCare meanwhile, has estimated the overall cost of back pain – to the NHS, business and the economy – at £5bn per year.
Just as worrying, the spread across the country is pretty even, about one in every 100 except in the north east of England, where the rate is higher, perhaps reflecting its heavy industrial heritage.
The Chartered Institute of Personnel and Development’s (CIPD) annual absence survey earlier this year painted a very similar picture.
Its figures showed MSDs and back pain were by far the biggest cause of long-term absence among manual workers and a significant cause of absence among non-manual workers (see box opposite).
When it came to short-term absence, MSDs and back pain were in the top three causes for manual workers and top four for non-manual workers.
The fact that MSDs are still such a significant cause of sickness absence shows they are still a serious problem that employers have not yet got to grips with, agrees Cary Cooper, professor of organisational psychology and health at Lancaster University Management School.
While some of the original problems associated with MSDs – injuries as a result of constant use of heavy machinery, say – are becoming less prevalent, the changing nature of the modern, mostly sedentary, workplace does not mean repetitive strain-type injuries are becoming any less common.
In fact, the rise of modern technology, and the fact that more people have computers and laptops at home (and will often take work home or work in unsuitable conditions at home) needs urgently to be addressed, he suggests.
“These kinds of injuries do create a lot of days off. If you damage your back that is a real problem,” he concedes.
The real problem, he contends, is less among large employers that have OH departments and are able to source the best equipment and support but among small and medium-sized enterprises. SMEs have long been recognised as being a bit of a black hole when it comes to OH and as regards MSDs it is no exception.
“We should be spending more time concentrating on SMEs because that is where there are not OH departments and the equipment they have is not so good. That is where the problems lie,” he argues.
The best employers – those that recognise this is an area that needs constant surveillance and consideration – have changed their tune over the years, he adds. There has also been the driver of litigation and the cost associated with people retiring early or being laid off on medical grounds.
Where OH and employers in general could be changing things would be in instigating much wider health ‘MOTs’ for workers, he argues.
At the moment it is mostly top managers who get access to such regular health checks, and they are often seen as a perk of achieving a senior position within an organisation. While they certainly serve a purpose in keeping top talent fit, healthy and firing on all cylinders, why shouldn’t more lowly workers be offered the same benefit, he asks.
“We need to ensure that people who are vulnerable to these types of disorders should be assessed perhaps once a year,” Cooper says. “We do it for managers, why don’t we do it for employees too?”
MSDs are still one the biggest causes of absence, particularly for manual workers but now across the whole spectrum of the working population, agrees Ben Willmott, adviser at the CIPD.
“It is an area that employers do need to have strategies to address. There is scope for employers to manage long-term absence in general, and certainly MSDs, in a much more co-ordinated and systematic way than they are doing at the moment,” he warns.
One problem is the big gap between those that do – those with prevention strategies, OH, effective rehabilitation policies and so on in place – and those that don’t, he adds.
There is also a credibility gap between knowing what works and being prepared to do it.
The CIPD’s research, for instance, has found that the vast majority of employers agree that rehabilitation programmes are the most effective intervention when it comes to dealing with MSDs. Yet only 31% of employers have a rehabilitation programme in place.
Employers, in other words, recognise there is a problem that needs to be addressed, that they should be giving their workers help and support in tackling MSDs and that there is a real, ongoing need for such support. Yet under a third are prepared to do anything about it.
“One of the problems is that because these are long-term absence issues they will tend to be individual ones within a department and not seen as a priority problem,” argues Willmott. “It is easy when you have targets to meet and a department to run for managers to switch off, it can be out of sight out of mind,” he adds.
It is also important for employers to recognise that it’s not just enough to have a programme in place, it needs to be backed up by a clear, consistent, well-communicated policy too, he argues.
“From our study, just 36% of employers had a policy in place. But if you do not have a policy there will not be consistency in how MSDs are managed through the organisation,” Wilmott stresses.
He cites the example of Royal Mail, which has won plaudits for its work in ensuring that workers reporting an MSD get referred into OH from day one. Since a range of initiatives were introduced (including the company’s notorious ‘don’t go off sick and win a car’ scheme), unplanned absence within the service has been reduced from 6.4% to 5.7%.
The HSE has also highlighted the success of British Polythene Industries (BPI) in reducing MSDs among its 3,500 employees.
In the mid 1990s, an average of 26 working days were being lost for each MSD absence. In response, BPI engaged MSD specialists Osteopaths for Industry, who provided a “musculoskeletal injury management system”, giving the company access to a network of 3,000 osteopaths, chiropractors and physiotherapists.
Workers reporting an MSD had an initial assessment by a registered physical therapist, after which, with the employees consent, a detailed report was sent to BPI giving details of the injury, the estimated number of treatments required and whether or not the employee was fit for normal duties, restricted duties or not fit.
Since 2001, the company has seen more than 75% of staff remaining in work while undergoing therapy, a substantial reduction in civil compensation claims and lower than anticipated increase in employers’ liability insurance premiums. In essence, the company calculates it has saved 12 for every 1 spent on the return-to-work scheme.
Another key factor in tackling MSDs, suggests the CIPD’s Wilmott, is to ensure proper training is in place so that everyone is working together correctly, including employers and OH practitioners with local GPs, to agree the rehabilitation process.
“All these things will only happen if they are spelt out. You have to get the strategy in place to help organisations resolve these issues,” says Willmott.
So what is the latest thinking from OH practitoners on this? Greta Thornbury, in the July edition of Occupational Health, highlighted how some OH professionals in a number of companies are working to reduce MSDs.
She cited, for example, Joe Patton, senior OH and ergonomic adviser to Allied Bakeries who introduced an occupational healthcare programme, which has reduced sickness absence and early retirement due to musculoskeletal problems.
Patton profiled the company’s sickness absence form certificates and prioritised health improvement initiatives and progress against targets.
In doing so, the number of cases of sickness absence fell by 20% and work days lost by 30% – a reduction of 3,437 sickness absence days over three years.
The article also looked at MSDs at Walkers Snack Food and Johnson Controls, where significant reductions were achieved using a multidisciplinary approach involving OH, ergonomics, safety team reps and team leaders.
A clinical physiotherapy service provided early intervention, prevented further injuries and co-ordinated existing injuries for a rapid return to work.
There are, of course, also issues around how closely mental health and stress-related conditions are themselves related to the prevalence of MSDs. What is clear from the OH perspective, however, is that the prevention and treatment of MSDs requires a firm hand, clear communication and a sound, evidence-based approach.
The HSE argues, somewhat self-evidently, that it is only through proper monitoring of sickness absence that you can start to identify the causes of MSDs, and so enable them to be tackled early on.
Proper monitoring and early contact, too, enables individuals with MSD problems to be indentified earlier on in their absence so a rehabiliation and return-to-work programme can be arranged.
A multidisciplinary teamwork approach will normally help, as will strong, transparent and very visible support from management (including line managers). There also need to be sound policies and clear procedures in place for support and rehabilitation of employees.
Yet, for all their worth, these are all practicalities; details about how you deal with the issue rather than taking a step back and asking whether we should be looking at the whole issue in a different way.
As both Cooper and Willmott point out, employers can still and should be doing more – a lot more – to tackle MSDs in the workplace. Stress and mental illness may grab the headlines but, for many thousands of workers, it is MSDs that are the real pain.
OH can be the conduit for change, but without a sea change in culture and thinking among employers, within the boardroom and down to line manager level, OH can only do so much.
Learning points for OH
- Early intervention, and ideally prevention, is the key
- A multidisciplinary approach will help, including using GPs
- Activity needs strong support, engagement and buy-in from management at all levels
- Processes need to be backed by a consistent, clearly communicated policy on management of MSDs, rehabilitation and return-to-work.
Regional breakdown of work-related back conditions
Region Rate per 100 ever employed:
- North East 1.1
- North West 2.0
- Yorkshire and Humber 1.0
- East Midlands 1.2
- West Midlands 1.1
- East 0.98
- London 0.99
- South East 0.91
- South West 1.3
- England 1.1
- Wales 1.2
- Scotland 0.86