The coronavirus Covid-19 pandemic has upended “normality” and resulted in an unprecedented social and economic lockdown. So how have occupational health practitioners been coping? Nic Paton reports.
It is fair to say the coronavirus Covid-19 pandemic has upended “normality” in ways few of us could have imagined, leading to an unprecedented social and economic lockdown, and occupational health has been affected just like every other economic sector in the UK and across the world.
OH professionals across the spectrum have been implementing crisis contingency measures to maintain business continuity and continue working with their clients or organisations during these challenging times.
Remote and home working has been implemented where possible although on-site working has, naturally, become harder as restrictions on all but “essential” working have become tighter.
For many providers, especially smaller and self-employed operators, contracts and work have ground to a halt, whether temporarily or not, leading to cashflow concerns and financial anxieties.
Home working and remote surveillance
So, first, how have practitioners been coping and surviving?
“The impact has been marked,” Janet O’Neill, clinical director at PAM Group told Occupational Health & Wellbeing. “We have had to move entire teams to home working in a very short space of time and I am amazed how quickly we managed to do this (although we had undertaken some prep). In some cases, people’s whole workstation, including chair, were picked up, put in a car and sent home.
“Almost all work has become remote with protocols built for remote health surveillance days before the HSE advised this. We were then able to implement very quickly. Our advice line and EAP service are running at full tilt to support our client’s queries and it is amazing how quickly we were able to utilise clinicians in differing areas.
“I am so impressed with the resilience and response to the situation of our workforce. Although we were fortunate in that we already undertook some remote work; it has shown what is possible going forward, in relation to flexible and home working.
“We have NHS and government-based clients who are essential workers and going through an enormous strain so it is good to know we are still able to support these cohorts of people,” Janet added.
“I’m working so hard I am so overwhelmed – at times I could cry!” admitted Su Chantry, occupational health manager at Williams Performance Health, and reflecting the mental dislocation and uncertainty many of us will have been feeling at the speed at which things have changed.
“Strategically, as a public health nurse advisor, I have had a critical in-house role to advise and steer the business in regards to health risk management,” she added.
Priorities in this context (in no specific order) had included advising on quarantine questions, ensure handwashing practice is followed and that sanitiser supplies remain optimum, maintaining and sharing up-to-date evidence and safeguarding critical health risk groups, Su explained.
There had been close liaison (often daily) with HR and executive teams, as well as needing to deal with individual enquiries from worried staff members.
Other priority activities had included advising the Health and Safety Executive over the suspension of health surveillance, daily departmental visits to reassure and generally allay myths and anxieties, monitoring and reading academic papers and government or other advice, reporting and logging cases and advising on isolation guidance, among others.
“I’ve been working late into evenings and weekends, as this is a 24-hour operational business. I’ve also been offering intermittent help to my local GP surgery, for example helping with the assistance call lines.
“As an independent OHN, my private work has dried up – all clinics cancelled. I’m lucky I am also in a PAYE role, but the industry of F1 isn’t secure,” Su said.
“It’s been a time like no other,” conceded Karen Coomer, OH nurse specialist at K C Business Health. For her, her work was now being broadly split into two main areas. First, it was about supporting clients and organisations strategically. “This has been helping to put systems in place to identify the vulnerable workers and how social distancing and necessary hygiene measures will work in the workplace, especially factories; a classic risk assessment approach,” Karen explained.
The second focus had been around providing more specific support and advice to individual employees and employers, for example dealing with calls from key worker employees concerned that they should be isolating from work because of health conditions, yet not fitting the government criteria.
“GPs have told some of these to talk to their OH services. So it has been about talking through their health issue, the science/evidence and where they fall in terms of risk,” Karen told Occupational Health & Wellbeing.
“Ninety-nine per cent have felt reassured, the odd ones still want OH ‘permission’ to stay off work – I have had to stick to the government guidelines quite firmly with these employees. Of course, this is all driven by fear, so an empathetic but rational approach has been key.”
A second key area of activity had been referrals from HR professionals struggling to keep things as much “business as usual” as possible. “This has included three urgent assessments on fitness for a disciplinary (all key workers), a couple of electronic health record (EHR) applications, mental ill health issues with known vulnerable employees and physical/mental problems with home working,” explained Karen.
“This has meant prioritising what is important just now and what is possible in progressing some referrals. For example, I will not be contacting any NHS staff for EHR medical reports,” she added.
With so much information as well as disinformation around about coronavirus, a further key role has been in advising employers on what information is accurate and reliable and what isn’t.
As Karen explained: “For example, in the early days some of my clients were sent information from companies about testing kits for £150 each! Reliability and specificity was very dubious. I expect this will be topical again when testing is more available and government-approved.”
Given the focus on handwashing to prevent the spread of the virus, the final key area of activity had been advising on and risk managing skin issues such as dermatitis. “I know hand dermatitis is becoming/is a problem in the NHS, but we are also seeing it with keyworkers in schools and manufacturing,” said Karen.
More generally, just like many within the profession, it had been a question of working to adjust to remote working and adapting her practice to include telephone calls in the evenings and over this weekend because employees are also looking after children. “I have done a home workplace assessment using FaceTime and Zoom, as well Google Hangouts for meetings,” Karen explained.
“I think my work will probably decline now as all the more immediate problems are dealt with although, who knows, it may not! However, I have applied to go back into the NHS and am currently being fast-tracked to work in the OH department of my local trust.
“Anecdotally, I have already had emails from independent OH nurses whose work has dried up and/or been laid off. So very difficult times ahead for some,” she added.
Loss or cancellation of work
This issue of the loss or cancellation of work and contracts has been a key worry for many others, too.
“We’re now on total lockdown, which was inevitable. For us it’s weird. We are a fledgling company and just gone through a period of massive growth, so I am concerned about supporting them,” said Pippa Crouch of Global Occupational Health Solutions. “The general feeling is to collaborate and share as much as we can in the current situation.”
“I’ve registered my potential availability to work in some other capacity to support the NHS but I’m terrified that I will have to follow through,” conceded Libby Morley, owner of Mindshift Consultancy.
“I feel safe at home but massively guilty and helpless. 75% of my work is around going into the workplace to deliver courses and that’s all stopped. I’m probably going to use the Zoom video platform and offer some short courses,” she added.
“Very worrying times for everyone! Very concerned for my clients and contractors. We are all in a very grave situation!” said Eddie Kooiker, managing director of K2 Associates.
At the National School of Occupational Health, all strategic work had been paused and the focus very much put on supporting the NHS, said the school’s deputy head Mandy Murphy.
“Occupational Medicine trainees are still being supported in their clinical placements although this is quite fluid, as many are supporting businesses or returning to NHS services.
“I have released complimentary coaching sessions each week for OH professionals to have a safe space, talk about how they are finding their feet or work on an imminent issue re their work or their business if self-employed,” she added.
“Sometimes an impartial sounding board is useful to create space at a time like this, as it’s difficult to get grounding when being pulled in all directions (not only by clients but families too). Having supported NHS services through various epidemics and health emergencies, this is not one I ever imagined I would see get to this stage. It’s very surreal,” Mandy said.
Some EAP providers had been seeing a downturn of calls, while others were experiencing a huge increase never seen before, said Eugene Farrell, chair of the EAPA (the UK Employee Assistance Programmes Association).
“We must bear in mind that EAP providers have staff too who may be affected by the virus directly or face self-isolation. At present we see a mixture of home working and at office counsellors. Very few providers are working entirely at home,” he said.
“Mental health support is essential work for the nation and will increasingly be so as this crisis lengthens and deepens. Whilst not frontline, EAPs will need to play an important part in supporting essential workers and those being asked to work at home or in isolation.
To that end, much of the support provision had, unsurprisingly, shifted from face to face to remote. “EAP has predominantly been a face-to-face support after the initial call. However need necessitates that telephone support sessions will become the new normal during this national crisis,” he added.
One way or another, for individual practitioners and the occupational health profession as a whole it is very clear the next few months are likely to be a test the like of which most will have never experienced before.
Advice and support
The profession has come together in the past few weeks to pull together extensive advice and support for practitioners working out in the field or trying to support clients from home.
For example, OH nurse Carol Sanders has collated an extensive guide on the currently available health and wellbeing information for iOH, The Association of Occupational Health and Wellbeing Professionals. This is available through its website.
SOM, the Society of Occupational Medicine, has been publishing regular updates and advice.
This includes pointers to a range of useful resources, including:
- Health and Safety Executive advice on health surveillance
- Health and Safety Executive advice on musculoskeletal issues and home working
- Advice on NHS practitioner health
- Business toolkits from Business in the Community
- Physiotherapy advice
- Further MSK advice
- Employment law FAQs from Thrive Law
SOM president Will Ponsonby has also been lobbying the government over ensuring NHS workers had adequate personal protective equipment during the crisis as well as working closely with the industry.
Again, its resources, as well as a useful library of blogs, can be accessed through its website.
Government and other support packages
With whole sectors being effectively shut down during the current crisis, the government during March unveiled an unprecedented range of measures to support businesses, employees and (eventually, after some delay) self-employed workers.
These have included:
- A coronavirus “job retention scheme” under which HMRC will cover 80% of employee salaries, up to £2,500 a month. Although these only become effective from April, the government has indicated they will be backdated to the beginning of March.
- Freelance and self-employed workers to get a guaranteed income of 80% of their monthly net earnings, averaged over the last three years.
- VAT payments deferred until the end of June, tax self-assessments deferred from July 2020 until January 2021.
- A Statutory Sick Pay relief package for small and medium sized businesses.
- A 12-month business rates holiday for all retail, hospitality, leisure and nursery businesses in England.
- A coronavirus Business Interruption Loan Scheme offering loans of up to £5m for SMEs.
- A new lending facility from the Bank of England to help support liquidity among larger firms, helping them bridge coronavirus disruption to their cash flows through loans.
- Mortgage lenders to offer temporary mortgage relief and three-month payment holidays for those struggling to make ends meet.
More information on the government support on offer can be found on the government website.