Category Archives: Work and health

Introduction

 

The  SHA Council agreed to pull together some of the existing policies on prevention and public health, introduce new proposals that have been identified and put them into a policy framework to influence socialist thinking, Labour Party (LP) manifestoes and future policy commitments. The SHA is not funded by the industry, charitable foundations or by governments. We are a socialist society which is affiliated to the Labour Party (LP) and we participate in the LP policy process and promote policies which will help build a healthier and fairer society within the UK and globally. An SHA working group was established to draft papers for the Central Council to consider (Annex 1).

 

The group were asked to provide short statements on the rationale for specific policies (the Why?), reference the evidence base and prioritise specific policies (the What?). Prevention and Public Health are wide areas for cross government policy development so we have tried to selectively choose policies that would build a healthier population with greater equity between social groups especially by social class, ethnicity, gender and geographical localities. We have taken health and wellbeing to be a broad concept with acknowledgement that this must include mental wellbeing, reduce health inequalities as well as being in line with the principles of sustainable health for future generations locally and globally.

 

The sections

 

These documents are divided into five sections to allow focus on specific policy areas as follows:

 

  1. Planetary health, global inequalities and sustainable development
  2. Social and the wider determinants of health
  3. Promoting people’s health and wellbeing
  4. Protecting people’s health
  5. Prevention in health and social care

 

The working group have been succinct and not reiterated what is a given in public health policies and current LP policy. So for example we accept that smoking kills and what we will propose are specific policies that we should advocate to further tackle Big Tobacco globally, prevent the recruitment of children to become new young smokers, protect people from environmental smoke and enable smokers to quit. We look to a tobacco free society in the relatively near future. Whether tobacco, the food and drink industry, car manufacturers or the gambling sector we will emphasise the need to regulate advertising, protecting children and young people especially and make healthy choices easier and cheaper through regulations and taxation policies.

 

Wherever appropriate we take a lifecourse approach looking at planned parenthood, maternity and early years all the way through to ageing well. We recognise the importance of place such as the home environment, schools, communities and workplaces and include occupational health and spatial planning in our deliberations.

 

We discuss the NHS and social care sector and draw out specific priorities for prevention and public health delivery within these services. The vast number and repeated contact that people have with these servces provides opportunities to work with populations across the age groups, deliver specific prevention programmes and use the opportunities for contacts by users as well as carers and friends and relatives to cascade health messages and actions.

 

The priorities and next steps

 

In each section we have identified up to ten priorities in that policy area. In order to provide a holistic selection of the overall top ten priorities we have created  a summary box of ten priorities which identify the goals, the means of achieving them and some success measures.

 

This work takes a broad view of prevention and public health. It starts with considering Planetary Health and the climate emergency, global inequalities and the fact that we and future generations live in One World. A central concern for socialists is building a fairer world and societies with greater equity between different social classes, ethnic groups, gender and locality. We appreciate that the determnants of such inequalities lie principally in social conditions, cultural and economic influences. These so called ‘wider determinants and social influences’ need to be addressed if we are to make progress. The sections on the different domains of public health policy and practice sets out a holistic, ecological and socialist approach to promoting health, preventing disease and injury and providing evidence based quality health and social care services for the population.

 

The work focuses on the Why and What but we recognise the need for further work to support the implementation of these priorities once agreed by the SHA Council. Some will be relatively straightforward but others will be innovative and we need to test them for ease of implementation. A new Public Health Act, as has been established in Wales, but for UK wide policies would make future public health legislation and regulation easier.

 

The SHA now needs to advocate for the strategic approach set out here and the specific priorities identified by us within the LP policy process so they become part of the LP manifesto commitments.

 

Dr Tony Jewell (Convener/Editor)

Central Council

July 2019

The complete policy document is available below for downloading.

Public health and Prevention in Health and Social carefinaljuly2019

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Security staff at Southampton General Hospital being attacked in the A&E department is key to an industrial dispute over pay and sickness pay.

Unite, Britain and Ireland’s largest union, said its 21 security staff members were being attacked on a regular basis by members of the public either under the influence of drink or drugs, or with mental health problems.

Unite is currently holding a ballot for strike action or industrial action short of a strike of its members, employed by Mitie Security Ltd, at Southampton General Hospital over pay and conditions. The ballot closes on Wednesday 15 March.

Unite said that Mitie Security was refusing to provide adequate personal protection equipment (PPE), such as stab vests and  safety restraints, even though knife-related incidents are increasing.

Unite lead officer for health in the south east Scott Kemp said: “With cuts to the police force and mental health services, there is a tendency for those suffering from various conditions to be dropped off at the hospital and left to the security guards. 

“The statistics are not easily available as to the number of our members who have been injured. There has been a lack of proper investigation into the incidents over a considerable period.

“The guards report incidents that have occurred on every shift, but the bosses at the University Hospital Southampton NHS Foundation Trust and Mitie Security will only investigate when someone is injured.

“Our members are very concerned over incidents occurring right across the Tremona Road site when there has been little or no support from the police who are under pressure because of government cuts.

“Our argument is that we should not have to wait for someone to get injured before a full investigation is instigated.

“That is why the sick pay arrangements are really important. At present, if the security staff are injured at work, and if the resulting investigation finds in their favour, they get two weeks’ full pay and then two weeks’ half-pay. After that, it is the statutory minimum.

“We have members getting beaten up and then having to return to work after two weeks, when they are clearly not fit to, as to drop down to half-pay would mean missing mortgage or rent  payments and significant financial hardship.

“What we want is enhanced sickness payments for those off work due to being injured protecting patients and hospital staff; proper and transparent investigations into all attacks; and our members having the necessary personal protection equipment.

“Our members are seeking six months’ full-pay, followed by six months’ half-pay for all sickness absences. We don’t think those are unreasonable requests, given the level of violence in today’s society generally.”

Unite said that the demand for an increase in pay from the current £8.64 an hour reflected the stress of the job. The security staff are seeking £10.50 for security officers and £12.16 for supervisors, with additional payments of 50p per hour on night rates; £1 an hour on Saturday and double time on Sunday.

Scott Kemp added: “Our members are at the forefront of providing security and a safe environment for staff, patients and visitors – that’s why Mitie’s management needs to get around the table and negotiate constructively.

“There is now a good window of opportunity for such talks before the ballot for strike action closes on 15 March.”

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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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