Category Archives: Work and health

For so long now, the burden of providing a safe working environment has lain on the shoulders of a company and its management. Health and safety standards are becoming stricter and more steps are being taken to prevent workplace accidents from happening.

In recent years, however, employees – the workers who are actually interacting with the work environment – have become more involved in maintaining sufficient levels of safety. Studies compiled by the Health and Safety Executive show better training and higher employee engagement in health and safety programs. There are a few reasons why this shift is a great thing.

Better Employee Participation = Fewer Accidents

Employees have always been the leading edge of health and safety implementation. In the old days, employees were given internal training on HSE policies and how to follow those policies to the letter. While this worked to a certain degree, employees weren’t really involved in the process of maintaining these health and safety standards.

Today, the process is reversed. Instead of asking employees to follow a certain set of rules, companies are beginning to get employees involved earlier in the process. Key employees with deep knowledge of the working environment can now influence workplace HSE policies.

The impact of this shift is tremendous. Accidents in companies whose employees are actively engaged in maintaining health and safety standards are up to 90% lower compared to companies that enforce their HSE policies on to workers. It really shows how a simple shift in paradigm can really influence the entire working environment for the better.

More Training for Employees

It is also important to note that health and safety training is no longer only about the policies. Sure, employees need to know the right procedures and the steps to take when faced with certain challenges. However, it is also better to equip employees with real skills related to health and safety.

More employees are voluntarily signing up for first aid training courses than ever before. Companies only need to provide the training and employees can choose to participate in courses. Engaged employees also suggest the kind of training that will be useful in their workplace and beyond.

The latter part is also important. Health and safety training for employees is no longer designed solely to protect them at work. Skills like first aid are useful in everyday situations too. This is part of the reasons why employees are more willing to take the training courses they find useful.

A Step in the Right Direction

All stakeholders must be involved for a truly safe working environment to be created and maintained. The increase in employee engagement when it comes to health and safety in the workplace is a definite step towards the right direction.

It is now up to the big corporations to further stimulate employee involvement and gain support from other stakeholders. More changes are coming and getting employees involved in shaping those changes is the best way to ensure maximum safety in the workplace. After all, a safe workplace is a productive workplace.

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40% of cancer patients said they felt discriminated against when they returned to work.

After suffering from a serious illness it’s a natural to want to get back into your normal working routine, if your body has been compromised physically your confidence has probably been knocked, nothing can ever prepare you for the shock and strain on both your body and your mind.

Randstad have put together a new campaign all about returning to work after various circumstances, from serious illness to retirement, mental illness to maternity. In this series Randstad spoke to workers to describe the challenges and emotions of returning to work after a prolonged absence.

Heading back to work after an extended absence will undoubtedly mean a change in your daily routine. For most it won’t be as easy as picking up where you left of and it is important to listen to your mind and body when making the first steps to retuning to work. There’s plenty to think about but here are four crucial things to consider when the time comes.

Ask your GP

It’s a good idea to consult with your GP or your healthcare professional about whether you are physically ready to go back to work. You might feel like you are ready, but recovering from a serious illness really does take time. If they also agree that you are ready to return to the working world, ask them to create you a ‘fit note’ which explains your illness and that the GP has given you the go ahead to start working again.

GP - Returning to work

Don’t rush

It can be tempting to rush back into work as quickly as possible, you may even see it as the end of your recovery and the boost you need for kicking a serious illness. However, it pays to be patient, there is nothing more disheartening then attempting to re-join your workforce and having to leave again because you rushed back when you weren’t quite ready. It may be boring and feel like you are wasting valuable time, but it will be worth it in the long run.

It can also be a good idea to start slowly, with shorter days or coming in a few days away for the first couple of weeks to ease yourself back into it.

Think of number 1

In an ideal world everyone would have a supportive network of colleagues and management, but unfortunately this isn’t always the case. It is important not to let others dictate the terms and speed of your return to the workplace, as this can hinder your efficiently and productivity. If you find either management or colleagues putting pressure on your to either get back to work too soon, or commit to arrangements which are currently not working for you, don’t be afraid to push back and say so, only you know your capabilities and what is right for you.

Be honest

It is important regardless of whether you are returning to work at an old job or starting a new one, to be honest with your employer about your condition, any special requirements you may have or anything that will ensure a smooth return to work. Not only will this ensure you are respected within the workplace, your employer will see you as a trusted individual who can manage their own circumstances and commitments carefully. It is important to be honest from the beginning, as this will help not only yourself but also your boss to set realistic performance targets and timelines.

Ensuring you surround yourself with supportive family, friends and most importantly colleagues, without setting too high expectations of yourself will ensure a smooth and healthy return to work.

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Safety at work is something that everyone has to consider: from desk bound office workers right through to those handling dangerous chemicals or performing tasks at extreme heights or temperatures.

One of the most important considerations is the atmosphere around us. If the air that we breathe is in any way contaminated it could spell serious issues for our health.

The Health and Safety Executive has found that there are about 36,000 people who worked in the last year – and 141,000 who had ever worked – who have breathing or lung problems they thought were caused or made worse by work, with 14,000 new cases each year.

With those numbers in mind, it’s easy to come to the conclusion that yes, you are at risk of a breathing problem when you’re at work. And in some respects that is the case. Even a dusty desk or a stuffy office can contribute to sore throats and headaches in a low level sense.

Yet it isn’t all bad news. With this risk in mind, the Health and Safety Executive has what is known as the Control of Substances Hazardous to Health Regulations 2002. That’s not the catchiest of names, granted, so these are generally known as COSHH.

This is a law that requires employers to control any substances that are hazardous to health. In essence it means that the employer is responsible for:

  • Carrying out a risk assessment to discover hazards
  • Identifying what needs to be done to prevent them becoming an issue
  • Making sure the right equipment is used and working practices followed
  • Providing training for employees
  • Monitoring their operation to make sure things are running smoothly
  • Having a back-up plan in case anything goes wrong

Does your business do all of that? If so, you can feel rest assured that the risk to your health is being mitigated. If not, your risk might be greater than necessary.

Communication is also vital. Companies that do best at protecting the health of their workers are the ones that are effective communicators – passing on the right information to the right people as and when necessary. They also listen to the concerns of their workers and understand them – taking note of things such as respiratory health problems, which might put people in greater danger.

Companies also need to be proactive. Some of the most common hazards come from paint, bleach and dust – hardly rare and exotic chemicals. It’s up to businesses to spot where such things are commonplace and investing in the right equipment to help, whether that be PPE such as masks and clothing or equipment that can remove dust from a busy working environment.

The best bosses realise that an unhealthy workforce is an unproductive workforce and care about their staff from both a pastoral and practical perspective.

The rules, however, are clear. Bosses have a responsibility to protect their employees and to do their bit to avoid adding to the sorts of statistics outlined above. They have access to all the information they need – with industry-specific direct advice sheets freely available – and should be able to make the risk of respiratory problems be as low as possible. With that in mind, you might well conclude that the quality of your boss is as important as the nature of your work when it comes to the risk you face.

 

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Recent figures show that only one third of workers who experienced a mental health problem in the last five years felt well-supported by their managers. Line managers routinely overestimate how well their workplace supports staff’s mental health and wellbeing, and less than a fifth of workers with mental health issues said they actually received the kind of support that would help them to remain in work.

But why is this happening? Well, there’s a perception that those with mental health problems won’t be able to cope with workloads and the stresses and strains of the workday, which stops people discussing their health issues with anyone at work. There’s also an erroneous belief that those who suffer with mental health issues are simply using it as an excuse to get off work. There’s also a fear of the gossip, pressure and bad-treatment from colleagues who see an employee with mental health issues as being ‘deadwood’ to a company, all of which culminate to add to the stigma surrounding mental health.

So what can employers do?

One thing employers could do to de-stigmatise mental health issues in the workplace is to enable employees to remain in work with adjustments to their role. This is already a requirement under health and safety law, with employers being subject to a general obligation to take reasonable care for the health and safety of employees in the workplace, which means they have a duty towards people who may have mental health issues.

Employers also have a legal duty not to discriminate because of a person’s disability (and in some cases, mental health issues can constitute a disability). However, it’s clear that there needs to be more flexibility than the law currently has the power to enforce, such as making an alteration to responsibilities where appropriate, or an adjustment to contracted hours or place of work. Both these solutions could go some way to closing the gap between duty and what happens in reality.

And, while there’s no magic software solution or technological shortcut to improving a culture of understanding mental health or tackling mental health issues directly, investing in the right infrastructure could free up HR professionals to innovate and focus their attention to other things, including mental health. Employers ought to start investing in HR services on a larger scale, including the use of software to automate processes, as this could ensure HR professionals have time and capacity to focus their attention on matters as pressing as mental health.

In addition, employers could reduce stigma around mental health by encouraging their employees to prioritise their own mental wellbeing, which means offering more sick days at full pay, preventing burn-out and achieving a healthy work-life balance. This might require better resourcing, a review to the number of sick days issued to staff, and a company culture of taking lunch breaks and leaving the office on time: a pipe dream for many, perhaps, but a major step towards looking after the mental health of all employees.

Open communication is also required, as a lack of communication and understanding is perhaps the largest source of stigma around mental health in the workplace. This might mean holding learning lunches on the subject, organising training from external agencies, making support from mental health professionals available or even subsidising treatment such as counselling services.

Furthermore, much of the stigma around mental health in the workplace could be reduced by enabling mangers to help others. This will require training managers so that they feel confident supporting their team, recognising mental health issues and knowing how to communicate confidently about them. Chris O’Sullivan, head of workplace mental health at the Mental Health Foundation even suggests encouraging those who have relevant experience to use it to support others.

For example, he suggests that it might be valuable for managers to share their lived-experience of dealing with mental health issues. Whether or not this is a solution to de-stigmatising mental health depends on a manager’s willingness to share their experience, (and there certainly shouldn’t be any pressure placed on managers to do so), as respect for their privacy and facilitating the separation of their personal life from their work life is key. Managers should only be encouraged to share their personal experiences if they are genuinely willing to do so.

Finally, employers need to work on the gap between policies regarding mental health and the actual everyday experiences of employees. Can a business truly be said to be aware, understanding and accommodating of mental health issues if their staff are routinely overworked, stressed, under-resourced or over-burdened? Is their sufficient provision for sick days, and would a mental health issue be challenged, sneered at or simply not accepted if someone called in sick for depression, anxiety or a similar mental health issue? 

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When it comes to health care in the work place, there are some differences between the UK and America. In the UK for example there is statutory sick pay incase employees need it when they fall unwell however in the U.S there is no guarantee for any sick pay.

The infographic below highlights some of the differences between working in the UK and the U.S including the perks and benefits! Take a look to see the main differences between the two…


Work Culture UK vs USA

Provided by Foothold America

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The air we breathe should be safe, right? Which is why as an employer, it’s imperative that you keep workers protected from polluted, unsafe air that could cause respiratory issues and more serious health problems later down the line. So, how can you ensure respiratory health is protected for your workers? Here are a few things to consider:

Do you have the correct RPE?

RPE (Respiratory Protective Equipment) really is the first thing to put in place when dealing with environments or tasks that may affect respiratory health. Let’s say your business works on the railway and deals with ballast dust – this can cause serious respiratory issues because of the Respirable Crystalline Silica in it. Therefore, dust masks are essential when working with such conditions. For men, shaving is recommended when wearing a dust mask to ensure the seal is effective. The correct PPE for the job can significantly minimise the risk of poor respiratory health at work.

Are ventilation measures in place?

If your employees are completing tasks in a small or closed area, then adequate ventilation is paramount. Ensure windows and doors are open to allow airflow if possible, or install filters designed to reduce the amount of hazardous substances in the air.

Are you aware of the symptoms of skin and respiratory sensitisers?

It’s important you can recognise when members of staff are becoming sensitive to their working environment. Symptoms usually include wheezing and tightness of breath, coughing and dermatitis. If anyone is displaying these symptoms you must restrict the amount of time they’re working in the contaminated environment and ensure they seek medical attention immediately.

Have your staff had training?

It’s essential that your staff are trained on how to conduct themselves in workplaces where respiratory issues may arise. Ensure they undertake training regularly and are instructed on any new measures that may come into force over time.

Do you understand your legal requirements?

As an employer, you have a legal duty to ensure your staff are protected at all times. The Control of Substances Hazardous to Health Regulations 2002 (COSHH) require an employer to regularly assess your worker’s exposure to substances, check that control measures are securely in place, and require you to decide which precautions to take to prevent harm. You are also obliged to present your workforce with a copy of any COSHH assessments conducted by your business. These assessments should be carried out regularly.

Respiratory health is important. You must ensure you are doing all you can to minimise risk and protect your employees from serious issues as a result of exposure to hazardous substances in their working environment. Take note of this list of things to keep in mind and ensure you and your workforce are protected.

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In a day and age where health and safety is at the forefront of our minds, you and your business will regularly be considering ways to increase and improve your safety procedures at work. All businesses and organisations have a legal obligation to put into place suitable arrangements to manage and monitor health and safety. Regardless of the size of your business it’s important to have effective leadership and management, fully trained staff and an environment where everyone is trusted and involved. Our checklist shows what should be considered when thinking about health and safety at work:

Equipment – Ensure that all staff have access to suitable equipment for them to be able to complete their tasks. Provide staff with carts and trolleys and equipment fitted with castors to make operations more efficient and improve safety. Click here to see the types of castors available for use in the workplace from Tente. Different types of castors are suitable for specific jobs. Staff may also need to be provided with items such as safety goggles, helmets, steel-capped boots, high visibility clothing and much more, depending on the task. After equipment has been provided it must be regularly checked and maintained to keep it safe to use. Put up signs around the workplace to remind people they must wear the equipment when required.

Training – Training is an essential element for any business, especially when it comes to keeping all your employees safe and if their job has potential risks of injury. The most basic training that should be completed on a regular basis is first aid. It is important that all staff are adequately trained in emergency procedures. Prepare written instructions and work practices so that all employees have a reference point for completing tasks once they have finished their training. Make sure that staff are supervised and regularly monitored to check that they are performing tasks properly and safely.

Planning – Assessing risks to employees is a crucial aspect of identifying hazards in your workplace. Once hazards are established it is easier to develop a safety plan. From this initial assessment it will be clear what needs to be done to ensure that the workplace follows correct procedures. Once your safety plan has been formed and shared with your staff it will be necessary to regularly check all areas of the workplace, including equipment and staff. Have regular staff meetings and discussions where health and safety matters are addressed to encourage employees to share their thoughts as they may have spotted something you have not thought about.

Monitoring – When incidents occur, even if they are minor, you will need to conduct an incident investigation to help determine why it happened so that you can take steps to ensure it does not occur again. Make sure that records are kept for all first aid treatment, inspections, incident investigations, and training activities. This information can help you and your business to identify trends in unsafe conditions or work procedures and help you take steps to reduce any further risks.

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 Magical thinking or evidence-based policy?

“To own the discourse is to win the argument”
The Green Paper on Work, Health and Disability  was published online late afternoon of Monday 31st October.  The DWP had been briefing since the Saturday before, that a major reform was proposed to the Work Capability Assessment and that all the evidence was that work is good for people’s health.
Newspapers and television news highlighted the proposals but no-one actually saw the document until news media had been running the DWP storyline for almost 48 hours  The BBC initially intended to film some interviews at a London disabled people’s organisation on Monday afternoon but cancelled it as by then the story was no longer news.
The consultation on the Green Paper is running until 17th February, long enough for individuals and organisations to get to grips with what is really being proposed.
I’ve focussed in this blogpost on three important contentions made in the Green Paper, on which some of its proposals are based.  I’ve tried to get behind the spin which accompanied its launch to see what exactly is being proposed.
Contention No 1:  There is a causal relationship between work and health, such that if someone moves from unemployment into work their health will improve.
The Green Paper opens with the statement that “The evidence that appropriate work can bring health and wellbeing benefits is widely recognised”. The reference for this is the major review of evidence, published by the DWP in 2006.
On the face of it, this is a fairly uncontentious statement.  The word ‘appropriate’ recognises that not all work has a positive impact and the phrase ‘can bring’ indicates that this is not a claim of a unilinear causal relationship.  Indeed, early on in the Green Paper the complexities of the relationship are acknowledged:
…….whilst work is good for health in most circumstances, the type of work matters. Many factors such as autonomy, an appropriate workload and supportive management are important for promoting health at work.
This reflects the conclusions of the 2006 review.  The Green Paper could also have drawn on more recent longitudinal research from Australia which found that low paid, insecure jobs, characterised by a lack of control, were associated with poorer health than that found amongst those people who remained out of work.
Getting a high quality job after being unemployed improved mental health by an average of 3 points, but getting a poor quality job was more detrimental to mental health than remaining unemployed, showing up as a loss of 5.6 points.
This is an important finding, particularly bearing in mind the conclusion of the DWP’s 2006 literature review that: “After leaving benefits, many claimants go into poorly paid or low quality jobs, and insecure, unstable or unsustained employment. Many go on to further periods of unemployment or sickness, and further spell(s) on the same or other social security benefits”.
Unfortunately, the tone of the rest of the paper and its proposals assume a straightforward unilinear relationship between being in paid employment and good health, as illustrated by what the DWP calls an ‘infographic’ on page 4 of the Green Paper.  This shows two circular relationships, good health and work on the one hand and worklessness and poor health on the other.
The Green Paper would have been more accurate if it had concluded that, while paid employment can increase your standard of living, social interaction and self-esteem, it can also be bad for your health and can create or worsen illness or impairment. Whether work is good for your health will depend on your state of health and the nature of the job. As, according to the DWP’s own evidence, people leaving benefits often go into poor quality jobs, they are less likely than the average person to find that paid employment has a good impact on their health.
Contention Number Two:  Withdrawal or reduction of income (or the threat of withdrawal) will increase entry into employment.
The payment of out of work benefits has always been conditional but since 2010 the conditions have increased and withdrawal or reduction of payment can now last from four weeks to three years.The assumption is that this threat of, or the actual experience of, withholding income will make it more likely that a person will take steps that increase entry into employment.
The recent decision to reduce, by almost £30pw, the money paid to people who have been assessed as being unfit to work but able to take on work related activity (the ESA Work related activity group) is based on the same assumption: the DWP claimed it will “remove the financial incentives that would otherwise discourage claimants from taking steps back to work”.
In an earlier blogpost I examined the evidence that DWP relied on to make this claim.  It’s worth reiterating that there is no evidence of a causal relationship between a reduction in benefit levels and an increase in employment amongst disabled and sick people.
There is, in fact, a more convincing case to be made that reducing or withdrawing income will make people less able to gain employment. An evaluation of the impact of benefit reduction found that the more benefit was removed the less likely they were to move into employment.  A study which carried out four ‘natural’ experiments in the US and in India concluded that poverty undermined people’s ability to think clearly, carry out tasks and to make good decisions (a conclusion which is perhaps obvious to anyone who has experienced the pressures that come with even short-term financial difficulties):
The poor must manage sporadic income, juggle expenses, and make difficult tradeoffs. Even when not actually making a financial decision, these preoccupations can be present and distracting. The human cognitive system has limited capacity. Preoccupations with pressing budgetary concerns leave fewer cognitive resources available to guide choice and action.
The widely disseminated conclusion from this study was that, because people living in poverty expend more of their mental capacity on managing with a low income, government programmes aimed at helping them should not impose what some called a ‘cognitive tax’ – such as complicated forms, frequent monitoring systems, onerous requirements to prove eligibility.  As the Behavioural Insights Team argue:
“The worries involved in making ends meet every day already deplete [cognitive] bandwidth so government services aiming to tackle disadvantage – such as savings schemes, employment advice and parenting programmes – should be required to pass a cognitive load test to ensure these services do not make it harder for people on low incomes to make good decisions for themselves.”
The Behavioural Insights Team is an organisation originally set up by the government (the ‘Nudge Unit’) and still partly owned by them. This study was carried out in partnership with the Cabinet Office.  We would normally expect their conclusions to be treated seriously but that does not appear to be the case in this instance.
Contention Number Three: ‘Employment support’ will reduce the numbers of people on long-term out of work benefits
The Green Paper indicates an intention to reduce the numbers of people in the ESA Support Group. These are people who have been assessed as having limited capability for employment and also limited capability for work-related activity – meaning that they are exempt from complying with requirements to take ‘steps back to work’.  Concern that there are ‘too many’ people claiming this type of benefit dates back to the 1990s when Invalidity Benefit was replaced by Incapacity Benefit.   A series of changes since then in the method and process of assessment have not had the desired effect of reducing numbers qualifying for long term sickness and disability benefit.
The Green Paper proposes yet another change in the assessment regime and an extension of ‘employment support’ to people who have been assessed as not able to either work or to engage in work-related activity.  Instead of one assessment (the Work Capability Assessment) there would be two: the WCA would assess financial entitlement and then everyone on ESA, whether in the Support Group or not, would be subject to a “separate process” which would decide whether “someone should engage with Jobcentre Plus or specialist programmes”.
People would be required to have continuing contact with a ‘Work Coach’ who: could have full discretion to tailor any employment support to each individual claimant. This approach would be truly responsive, allowing the work coach to adjust requirements and goals dependent on changes in a person’s condition or circumstances.
While Damien Green previously announced that those in the Support Group would not have to undergo repeated WCA assessment, this new system could potentially require repeated and continuing ‘discretionary’ assessment by a work coach as to what a person should be required to do.
So let’s look at whether there is any evidence that the ‘support’ to be offered by this new system is likely to increase employment amongst disabled people or people with long-term health conditions.
The first thing to point out is that the assumption underpinning the Green Paper’s proposals is that people who are unfortunate enough to experience ill health and/or disability and unemployment are not capable of – or are not to be trusted to – make decisions in their own best interests.  Instead it is the role of a State employee or contractor to do this.
So the Paper proposes that “trained work coaches could have discretion to make case-by-case decisions about the type of employment support a person is able to engage with” (para 132).
The second thing is that anyone entering this system gives up all right to privacy about personal information held on them by the “NHS, the adult social care system or through other benefit applications, such as from a Personal Independence Payment application” as the assessment for financial support (the current WCA) and the work coach would draw on these sources of information (para 135).
A third point is that the employment support programmes have not in the past been very successful at helping people on long-term out of work sickness/disability benefits to find and retain paid employment.  Only 12.5% of ESA new claimants on the Work Programme get a job outcome within two years. The equivalent figure for people moving onto ESA from Incapacity Benefit is 4.7%.  Work Choice, the specialist programme aimed at disabled people has a higher rate of success but less than 1 in 5 of participants are on ESA with the majority being on Job Seekers Allowance, so the programme has not proved its effectiveness with people on ESA.
As the government has previously announced, the Work Programme and Work Choice are being discontinued and replaced with a new Work and Health Programme.  However, this will only have 20% of the funding previously invested in employment support.
The Green Paper also proposes that the:
“earlier engagement between an individual and a work coach in Universal Credit will also serve as a gateway to a wider, integrated system of support offered by the Department for Work and Pensions and other agencies, such as the NHS and local authorities”. (Para 84)
This “wider, integrated system of support’ is called Universal Support and is intended to “assist people with their financial and digital capacity throughout the life of their claim”.
“Through Universal Support we are transforming the way Job centres work as part of their local communities to ensure they more effectively tackle the complex needs some people have and support them into sustainable employment”. (Para 85)
Unfortunately, this transformation is not borne out by the DWP’s own evaluation of Universal Support in the trial areas.  The evaluation, published in July this year, concluded:
“the results suggest that participation in USdl had no statistically significant impact on either digital or financial capability…..Overall, the estimated annualised cost of the eleven trials was just over £4 million. Staff costs made up £2.7 million of the total.”
So £4 million was spent with no resulting improvement in claimants’ ability to engage with the UC system or with managing their finances. (Incidentally, the Green Paper also holds up the Troubled Families programme as ‘another example of an integrated approach’.  It’s surprising that they infer that this programme makes any difference as the evaluation published recently “was unable to find consistent evidence that the programme had any significant or systematic impact”)
It is unlikely therefore that there will be sufficient assistance available through the specialist employment support programme.  And Universal Support is unlikely to be of much assistance in terms of helping people to navigate the complexities of the system. So what will be offered to people in the Support Group as part of the ‘claimant commitment’?  The Green Paper does not spell this out explicitly but it would seem that the intention is that Work and Health coaches will decide what kind of health-related intervention someone needs.
How long before part of the ‘claimant commitment’ includes a requirement to participate in a ‘health intervention’ of some kind and sanctions are attached to non-compliance?
It isn’t really employment support that is on offer – rather we are on the road to a situation where people who are too ill or disabled to work are required to subject themselves to health interventions that an employee (or contractor) of the DWP decides is good for them.
In summary….
It’s important that responses to the Green Paper home in on what is actually being proposed, rather than merely respond to the questions posed by the DWP.  The proposed changes are merely the latest in a long line of attempts to reduce the numbers of people qualifying for long-term out of work sickness/disability benefits.  If the assumptions on which the proposals are based are not backed up by evidence then they will be unlikely to have any more impact on reducing the disability employment gap than their predecessors.
And finally…..
Magical thinking refers to the false attribution of causal relationships. In the context of psychology it refers specifically to the belief that one’s thoughts by themselves can bring something about – or that thinking something is the same as doing it.
Not only does this Green Paper ascribe a fallacious unilinear causal relationship between work and health, but it replicates a common feature of government policy – the assumption that saying something will happen makes it happen.
This is the fourth time in my engagement with social policy that a government has complained about the number of people ‘languishing’ on long term out of work benefits.  The fourth time that proposals are made which will supposedly reduce these numbers.  Any bets on how soon we will see a fifth?
First published on Jenny’s blog
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Workplace Hazards - Reasons & Remedies image

A workplace hazard is anything that could cause a potential harm, injury, illness and even death to a person. Hazards are present in every workplace, so it is important that you know how to identify possible hazards at your workplace to be better prepared to control or eliminate them.

Hazardous substance in the premise.  These are substances that can have an adverse effect on the worker’s health. Examples of hazardous substance at work are:

  • Poisons
  • Substances that cause burns or skin irritation
  • Dangerous Goods which present an immediate hazard to people, property or environment due to its physical, chemical or acute toxicity properties.
  • Insecticides
  • Solvents, bleaches such as hydrogen peroxide and sodium hypochlorite
  • Spotting agents such as amyl acetate, acetic acid, hydrofluoric acid , aqueous ammonia and oxalic acid.
  • Solvents
  • Acids
  • Heavy metals such as mercury, lead, cadmium and aluminum
  • Petroleum Products

Possibility of side effects.When one is exposed to hazardous substance, possible side effects could include:

  • Headache
  • Birth Defects
  • Nausea and Vomiting
  • Kidney, liver or lung disorder
  • Disorder in the nervous system
  • Dermatitis and other skin rashes
  • Poisoning
  • Chemical burns
  • Reproductive hazards on men
  • Bodily injury
  • Decrease in life span
  • Change in mental condition which results from stress, traumatic experience and exposure to solvents.
  • Effects on a developing fetus for pregnant employees

Physical Hazards. This is known as a factor within the environment that can pose a harmful effect on the body without necessary touching it. Below are common examples of physical hazards:

  • Electricity
  • Radiation
  • Noise
  • Pressure
  • Heights
  • Vibrations
  • Heat and Cold Stress
  • Ergonomic Hazards
  • Equipment
  • Confined spaces

Psychological Hazards. This type of hazards affects the mental well-being or mental health of the employee which impacts the worker’s ability to work in a safe and healthy manner. This includes but not limited to stress, violence and other workplace stressors that affects the psychological well-being of the worker. Below are some factors that could result to psychological hazards:

  • Long working hours
  • High Emotional Demands
  • Poor work-life balance
  • New forms of employment contract
  • Work intensification
  • Workplace harassment
  • Occupational violence

Prevention is better than cure. Since you have already identified the possible sources of hazards at work, you may follow the steps below on how to prevent hazards at the workplace.

  • Regular workplace inspections.
  • Monitoring hazard controls
  • All hazardous products must be properly labeled to clearly identify the product and provide hazardous information about it.
  • Every employee should be provided with up-to-date education program to be able to understand the possible hazard substances and how to avoid the dangers that they could cause.
  • Implement safe work procedures and appropriate and effective administrative and engineering controls.
  • Purchase the safest substances possible
  • Identify the most qualified person responsible for carrying out the program

Responding to Hazards.The severity of the damage of workplace hazards depends on how soon the victim is responded. Take these notes in mind if a staff member has been injured.

  • Arrange first aid and support for the injured employee
  • Ensure that the injury has been reported as soon as possible
  • Inform the injured employee of their eligibility to claim compensation
  • Provide support to the worker through any injury treatment and return to work programs

Managing hazards.A safe workplace is expected to be provided to all employees to ensure that they work at their optimum potential. No one wants to work in a place where they feel that they are not safe and could be in danger any time. Read on to see tips on how to manage hazards at the work place.

  • Identify the hazards and determine who might be harmed and how
  • Decide on control measures and put controls in place
  • Review the controls to check its reliability and effectiveness
  • Control measures should be implemented through getting rid of the harm or prevent the risk
  • Replace substance with something less harmful
  • Apply administrative arrangement to limit the exposure to hazards

Once the causes of hazards at the work place and its possible remedies have been identified, you can ensure that you provide a safe and conducive work place to your employees. Hiring an experienced workers comp attorney could cost a lot so make sure that you eliminate possible danger and injury at work.

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whistleblowers

Jeremy Hunt claims to be on the side of patient safety, especially when it comes to hosting international conferences on the subject. The Department of Health have just released a video where he shows off “140 avoidable deaths” per week, but there’s no idea where the latest statistic has come from. He could have done another misinterpretation job – like he did with ‘that’ BMJ paper.

Whilst the machinery of how the operations and strategy work in the NHS may leave many people baffled, even the hardened specialists, patient safety undoubtedly touches us all.

As you’d expect, all registered Doctors, including obviously those with a ‘national training number’ denoting the Doctor has been selected for the demanding higher specialist training, are regulated by the General Medical Council. The statutory duty of the General Medical Council is, inter alia, “to protect, promote and maintain the health, safety and well-being of the public”.

There is therefore a positive obligation on all registered Doctors to promote patient safety, and this includes speaking out on such matters if need be. The regulator’s official line is to be sympathetic to the concerns of “whistleblowers”, but there exists a sad litany of victims who have blown the whistle who have failed to achieve gainful employment ever again.

There has been much concern about whether the Public Interest Disclosure Act (1999) as a statutory instrument is essentially “fit for purpose”. The general consensus is that it isn’t.

Benedict Cooper is an excellent article in the New Statesman explains how Chris Day’s specific case has come about.

“It all started one night back in January 2014. Day was working through the night on ICU at Queen Elizabeth Hospital, part of Lewisham & Greenwich NHS Trust. When two locum doctors failed to turn up to work on another ward, Day found himself dangerously stretched having to treat critically ill patients outside of ICU. Under what’s known as ‘protected disclosure’, he raised the matter and urged his manager to find locums ready to come in. It sounds innocuous enough – it’s been anything but since. Why? Because his case has revealed a major flaw in the system; a flaw that has cost him dearly. Unlike almost every other branch of the medical profession, junior doctors aren’t protected when they blow the whistle in the way Day did that night.”

The Chris Day is truly David v Goliath stuff. Health Education England, like the NHS in general, has access to powerful expensive corporate lawyers; and yet lawyers often talk of decisions being made ‘on public policy grounds’ referring, as the former Master of Rolls Lord Denning did, to “deep pockets” and “floodgates”. A consideration, albeit a pretty immoral one, is that Chris Day’s case might open other litigants to take action against Health Education England which has a huge budget.

For me, and I really do go into this with an open mind, the judgement was concerning as to how the decision-making of judgements occurs. There was, for me, a sense of reverse engineering of making the law fit the conclusion the Judge wanted to produce. This is a well known logical fallacy called “post hoc ergo propter hoc” fallacy.

The law always look behind the substance behind the form, so the English law is more interested in what the employment relationship is rather than what is called. It’d have been much more helpful for the Judge ‘to go back to basics’, in thinking about the nuts and bolts about the nature of Day’s daily work as well as his training, through the lens of the seminal Ready Mix Concrete v Minister for Pensions [1968].

The Judge should not have got wound up in detail but should have sought to produce an accurate picture of Day’s daily duties.

This is indeed advised in Hall v Lorimer [1993].

Nolan L.J. agreed with the views expressed by Mummery J. in the High Court where he said:

“In order to decide whether a person carries on business on his own account it is necessary to consider many different aspects of that person’s work activity. This is not a mechanical exercise of running through items on a check list to see whether they are present in, or absent from, a given situation. The object of the exercise is to paint a picture from the accumulation of detail. The overall effect can only be appreciated by standing back from the detailed picture which has been painted, by viewing it from a distance and by making an informed, considered, qualitative appreciation of the whole. It is a matter of evaluation of the overall effect, which is not necessarily the same as the sum total of the individual details. Not all details are of equal weight or importance in any given situation. The details may also vary in importance from one situation to another.

The process involves painting a picture in each individual case.”

 

The Judge then curiously pinned his reverse logic, which of course he is entitled to do as a lawyer of high standing, on what ‘parliament must have intended’.

This is, arguably, the most jaw dropping clause in the whole judgement.

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But the law as presented is left with startling lacunae, if the Judge is definitely correct.

Take for example this observation from Day himself on Twitter:

This based on the issue that s.43(k) Employments Right Act gives protection for a student nurse watching the operation ‘whistleblowing’, but not the doctor himself on the Specialist Register doing the said operation.

Normally, even the most junior law students would be advised to seek out any statutory aids to help to guess what Parliament might have intended. But only one year previous to the Employment Rights Act (1999), parliament enacted what it thought was extensive protection for whistleblowers, including in the NHS, in the Public Interest Disclosure Act (1998) as discussed here. Therefore, the same parliamentarians, led by the first Blair executive, were responsible for both statutory instruments. It is therefore inconceivable that it could be intended that junior doctors in training would be given protection in one statutory instrument, but not the other.

Furthermore, in response to the lengthy well articulated submissions on behalf of Dr Chris Day concerning article 10, freedom of expression, the Judge provides barely any discussion at all. This dismissal of fundamental human rights, brought into our domestic law through the Human Rights Act (1999), also legislated for by that first Blair government, is staggering.

The Supreme Court recently had to correct the law as interpreted by the lower Courts on joint enterprise. It is not inconceivable that they will have to correct the lower courts again this time on the Day case. But it is an important policy point – that registered medical doctors in training, despite having a duty to promote patient safety, are not protected in doing so. At a point when Jeremy Hunt’s popularity arguably is at its lowest ebb, his special advisors could do no worse than to encourage Hunt to correct the legislation urgently, a low hanging fruit that would make a huge difference on principle even.

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…the evidence below appears to indicate that it will…

Working welfare: a radically new approach to sickness and disability benefits

(Charlotte Pickles, Ed Holmes, Hannah Titley, Ben Dobson, February 2016, Reform Research Trust)

In the UK many disabled people want to work but are trapped on what remains a broadly passive system – almost three quarters of claimants who have had their Work Capability Assessment (WCA) are in the support group with no requirement to engage with, and little access to, support services. As the Organisation for Economic Cooperation and Development has argued: “what is needed is to bring the disability benefit scheme closer in all its aspects to existing unemployment benefit schemes”.

(Charlotte Pickles: Senior Research Director at Reform spent two years as Expert Adviser to Iain Duncan Smith helping to design and deliver the Government’s welfare agenda. Before that she was Policy Director at the Centre for Social Justice.)

Chancellor George Osborne’s Spending Review and Autumn Statement 2015 speech

From: 25 November 2015

We confirm we’ll extend the same support and conditionality we currently expect of those on JSA to over 1 million more benefit claimants…we’ll increase in real terms the help we provide to people with disabilities to get into work.

Working welfare: a radically new approach to sickness and disability benefits

When ESA was introduced it was expected that “the vast majority” of claimants would be subject to “a clear framework of rights and…responsibilities” – a minority of claimants would be in the support group. Instead, almost three quarters of claimants who have had their assessment are in the support group and subject to no conditionality, with very little support to return to work. This will have to change if the Government is to achieve its ambitious pledge to halve the disability employment gap.

THE CONSERVATIVE PARTY MANIFESTO 2015

We will aim to halve the disability employment gap: we will transform policy, practice and public attitudes, so that hundreds of thousands more disabled people who can and want to be in work find employment. We will help you back into work if you have a long-term yet treatable condition. We will make sure the hardest to help receive the support they need for a fulfilling life.

Working welfare: a radically new approach to sickness and disability benefits

With limited access to employment support and no work-related conditionality, people in the support group are completely detached from the labour market…This is bad for the individuals, society and the wider economy.

Rt Hon Iain Duncan Smith MP: speech on work, health and disability: Reform event 24 August 2015

We need to be relentless in our efforts to get more people into work and off welfare…that means getting 1 million more disabled people into work. The poor quality of support they receive leads too many sick and disabled people languishing in a life without work, when work is actually possible for them. Under Universal Credit, people can expect early and continued support about what work they can do and what support they need to do it, until they leave the benefits system.

Working welfare: a radically new approach to sickness and disability benefits

The vision for a single allowance: In practical terms, a single out-of-work allowance would mean removing the support group component, or in UC, the LCWRA element. [LCWRA is Limited Capability for Work Related Activity].

The ‘Limited Capability for Work-Related Activity’ descriptors only require one to be satisfied for admission to the ESA support group… 60 per cent of those in the support group have been on ESA for more than two years.

The Welfare Reform and Work Bill

As stated in the Explanatory Notes published by the Department for Work and Pensions, the Bill seeks to introduce the following measures:

  • Removing the work‐related activity component in Employment and Support Allowance [ESA] and the limited capability for work element in Universal Credit.

The Bill’s third reading in the House of Commons took place on 27 October 2015. Speaking on behalf of the Government, the Minister for Employment, Priti Patel: “Our welfare reforms are focused on transforming lives by helping people to find and keep work. We are focused on boosting employment and ensuring fairness and affordability, while supporting the most vulnerable, and on making sure that people on benefits face the same choices as those not on benefits and in work”.

Rt Hon Iain Duncan Smith MP: speech on work, health and disability: Reform event 24 August 2015

Under Universal Credit, people can expect early and continued support about what work they can do and what support they need to do it, until they leave the benefits system…with ESA becoming part of Universal Credit it is that access and human interface which opens the way for us to re-think the relationship between sickness benefits and work. I want to look at changing the system so that it comes into line with the positive functioning of Universal Credit. A system that is better geared towards helping people prepare for work they may be capable of, rather than parking them forever beyond work. We need a system focussed on what a claimant can do and the support they’ll need – and not just on what they can’t do.

Working welfare: a radically new approach to sickness and disability benefits

The Occupational Health Plan and personal budget – The Proximity to the Labour Market Diagnostic will result in a score which will determine which of four broad employment support and conditionality regimes the claimant will be placed in. If the health questionnaire triggers an Occupational Health Assessment [this] will be used to develop an Occupational Health Plan, which would be accompanied by a personal budget to facilitate implementation. This rehabilitative programme will be co-created by the health professional and the claimant, and the personal budget will be unlocked via a ‘dual key’ – the claimant and their employment adviser – to increase choice and control. For example, a plan might include talking therapies and recreational activities for suffers of mental health conditions. Those with muscular skeletal conditions might receive a course of physiotherapy. Once the plan is agreed, it becomes subject to conditionality.

Adult Improving Access to Psychological Therapies (IAPT) programme

The programme has already helped over 100,000 people move off sick pay and benefits. In the coming year, the focus for the programme of work will be on the following areas:

  • working with services to address the wide variation in access and quality
  • increasing the integration of psychological services with persistent physical health conditions
  • strong focus on support for those in employment or seeking employment
  • exploring how other mental health services can adopt an IAPT-like approach to service delivery i.e. outcome-focused; with core standards and performance monitoring; and developing datasets to build the evidence-base.

Working welfare: a radically new approach to sickness and disability benefits

Occupational Health Plan conditionality: The Government is now considering whether claimants who are unable to participate in the labour market due to ill-health might also be subject to greater conditionality relating to that condition. In February 2015 the Prime Minister announced that he had asked Dame Carol Black to undertake a review to “consider how best to support those suffering from long-term yet treatable conditions back into work or to remain in work”, including “consider whether people should face the threat of a reduction in benefits if they refuse to engage with a recommended treatment plan.”

The requirement would simply be that individuals claiming out-of-work benefits due to a mild or moderate health condition which with support could be treated or managed should be expected to take reasonable rehabilitative steps. The Government should pilot this approach to ensure it is applied sensitively and

appropriately, before rolling it out as part of the UC model.

The new out-of-work benefit model laid out in the previous two chapters allows a more personalised approach to conditionality for benefit recipients with a health condition. Effective conditionality helps to ensure claimants are taking the necessary steps to move off benefits and into work, thereby improving their health and wellbeing.

THE CONSERVATIVE PARTY MANIFESTO 2015

People who might benefit from treatment should get the medical help they need so they can return to work. If they refuse a recommended treatment, we will review whether their benefits should be reduced. We will also provide significant new support for mental health, benefiting thousands of people claiming out-of-work benefits.

DWP Central Freedom of Information Team

Increasing disability employment is a key part of the Government’s aim to achieve full employment. That is why this Government is committed to halving the disability employment gap by creating the opportunity for a million more disabled people to work. The Spending Review announced a new ‘Work and Health Programme’ which is intended to provide the best possible support for claimants with disabilities or health conditions as well as those who are long term unemployed. The Department will work with stakeholders on the design, including the structure and how people will be referred to the programme. (DWP Strategy FoI Team)

Working welfare: a radically new approach to sickness and disability benefits

The more than 1.3 million people currently in the ESA support group have been completely written off.

Policy paper: Spending review and autumn statement 2015 (Updated 27 November 2015)

As the numbers claiming unemployment benefits come down, spending on employment programmes can also fall. But at the same time, there is more to do to ensure that as many people as possible can benefit from the growing economy and higher wages. The Spending Review and Autumn Statement announces further measures to support people into work:

  • doing more to get people into work and make the system fairer – Universal Credit will extend the same Jobcentre Plus support that people on Jobseeker’s Allowance (JSA) get to 1.3 million additional claimants who currently get little or no support, by 2020
  • introducing a new Work and Health Programme after current Work Programme and Work Choice contracts end, to provide specialist support for claimants with health conditions or disabilities and those unemployed for over 2 years

Increasing employment levels amongst people with disabilities and health conditions is a key part of the government’s aim to achieve full employment…the benefit system continues to deliver poor outcomes for people with disabilities and health conditions. Universal Credit will provide greater up-front support for claimants with disabilities and health conditions from the start of their claim and enable them to be referred to specialist support from day 1 where appropriate.

In addition to these measures the government wants to improve links between health services and employment support, recognising timely access to health treatments can help individuals return to work quicker. The government will publish a White Paper in the New Year that will set out reforms to improve support for people with health conditions and disabilities, including exploring the roles of employers, to further reduce the disability employment gap and promote integration across health and employment.

Lords Hansard text for 07/03/2016 Welfare Reform and Work Bill Commons Reasons Motion A Moved by Lord Freud

Lord Kirkwood of Kirkhope (LD): “we must now engage in careful and urgent monitoring across the piece of how the ESA support group is catered for in future.”

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Doctors in the Neonatal Intensive Care Unit - always there for your baby

Doctors in the Neonatal Intensive Care Unit – always there for your baby

We’ve all been hearing a lot about the need for the 7-day NHS since Jeremy Hunt started to conflate the issue with the Junior Doctor Contract. As a piece of rhetoric, claiming that the NHS shuts down at the weekend or implying that all the lazy doctors just head home for Saturday and Sunday is an interesting one, being demonstrably untrue, but its repetition seems to be changing public opinions.

At this week’s Socialist Health Association AGM, both Andrew Gwynne MP and a GP member were enthusiastic about how progressive the idea of a 7-day NHS is, and how the Labour Party should support it. The phrases ‘the NHS should be there when people need it’ and ‘it will reduce health inequalities’ were used.

I believe those arguments are false. I believe that the weekend is different, special, and that supporting the Conservative government’s ideas is regressive for both staff and patients.

The first issue is about what we mean by ‘7-day NHS’. It is quite obvious to anyone who has been in or visited hospitals at the weekend that the NHS is up-and-running 24/7/365. Emergency and urgent care is provided around the clock by doctors and other healthcare professionals already. You will never find an Emergency or Maternity Department closed because it is the weekend. People in hospital over the weekend do not languish alone without medical care. So we already have an emergency 7-day NHS. The NHS IS THERE when people need it.

What the government are talking about is elective care. Routine appointments. Non-urgent surgery. Diagnostic services. The figures used to back this are claims that the lack of these services at the weekend causes higher death rates and unsafe care for patients – the ‘weekend effect’. This inequality needs addressing. Other people have debunked these figures more successfully than I can.

So what arguments are there against the new 7-day elective service?

Implementing the plan for 7-day elective services would in theory require more doctors, nurses, diagnostic and admin staff. Without more staff magically appearing fully trained, or more money to employ those staff, the work must be done by existing staff – either moved across from weekday care or working longer hours. Neither option is safe and forms one of the core issues in the junior contract dispute. Another key issue is the push to make Saturday ‘plain time’ – ie cheaper for hospitals.

However, if the ‘weekend effect’ isn’t real, we must ask what the motivation for creating cheap weekend elective services is. Two possible explanations which have not received much air time are the reduction of paid sick leave for 9-5 weekday workers, and the concept of ‘sweating the assets’.

Evening and weekend elective services are explicitly aimed at ‘hard-working people’ who currently have to take time off for routine appointments at hospital during the working week. Removing this type of employee sick leave from the books would result in large savings for some employers. Some would pressure employees to only accept weekend appointments. More would give positive bias to employees who managed to leave health maintenance outside the workplace, changing the culture of what it is acceptable to miss work for. Our patients with chronic health problems and disabilities would be worst affected, finding their lives outside work shortened by the need to attend appointments in this time. This time that otherwise they might spend with their friends and family, crucial social support.

Sweating the assets is the act of extracting the largest possible amount of work from your existing resources, whether they be human, financial, space or equipment resources. With hospitals currently providing very little elective care at the weekend, there is plenty of room for lucrative work to be done in this time. The hospital’s resources are not being used most efficiently unless they are operating 24/7, like a factory. With hospital trusts now allowed to make 49% of their income from private practice, there is opportunity to bring in wealthy customers in this time. With the private sector circling above our NHS like vultures, already picking off the more profitable bits, this could be the windfall that allows viable takeover.

Neither of these reasons is progressive.

Weekends are special and do deserve different treatment – unions have fought for them over centuries and we should not give them away so easily. For health workers, this is the time that would otherwise be spent with children or friends. It is the time we miss weddings in. It is the time when childcare is far more expensive. To work at the weekend is to give up more of yourself than during the week, and that should be recognised.

If we want to address health inequalities, then it is the social determinants of health – poverty, poor education, poor housing quality – that we should be attacking, not NHS staff.

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