Objective: to understand the differing roles of those in the multi-disciplinary occupational health team
APPRECIATE THAT DIFFERENT MEMBERS OF THE MULTIDISCIPLINARY TEAM HAVE COMPLEMENTARY SKILLS
It has been outlined in the Knowledge section that an occupational health team can include a variety of members with overlapping skills and areas of expertise. An occupational physician needs the support of other team members to deliver an efficient and effective occupational health service. One of the key factors when working in teams is recognition, respect and understanding of each member’s roles, responsibilities and areas of expertise working towards a common goal: the health and well being of the individual. Therefore teamwork is an essential part of occupational health practice.
The role of the occupational health professional (OHP) is to maintain the health and well being of individuals in the workplace. Research shows that overall, work is good for individuals’ health and well being (Waddell G and Burton AK, Is work good for heath and well being? 2006, London: TSO). Studies have also shown that being out of work can be detrimental to an individual’s health and that of the population in which they live. Therefore part of the role of OHP is to work with colleagues in the multidisciplinary teams to ensure that people are maintained in work where appropriate and maximise the health opportunities that work and social inclusion may bring.
Some facts about the health of people who out of work include the following:
- Unemployment has the equivalent health impact as smoking 10 packs of cigarettes per week (Ross 1995)
- The suicide rate in young men who have been out of work for more than 6 months is increased 40 fold (Wessely, 2004)
- The general suicide rate is increased 6 times in people with longer-term worklessness (Bartley et al, 2005)
- The health risk of being out of work in the longer term is greater than the risk of other killer diseases such as coronary heart disease (Waddell & Aylward, 2005)
An OHP is suitably placed to assess individuals in the workplace in a variety of ways. Examples of such benefits include:
- Assessing individuals following a period of absence to provide suitably individualised advice (rehabilitation programme) regarding a return to work. This can include advising the employer that an early return to work could be achieved by providing altered tasks for the individual for a defined period if time. For example suggesting someone who has acute low back pain might be able to return to work if they were not required to carry out heavy manual handling tasks for a period of two weeks. The doctor might also suggest the individual returned to work mid week rather than at the beginning of the week to allow them a reduced working week on their return. If the individual has been off work for a significant period of time the doctor might consider referring them to programmes such as Pathways to Work where individuals may access financial support and ‘condition management programmes’ which address the biological, psychological and social barriers to returning to employment.
- Provision of practical advice on reasonable adjustments in relation to employees who may be covered by the Disability Discrimination Act (DDA). The DDA places a legal obligation on employers to provide reasonable adjustments to employees covered by the act. Examples of occupational health advice on reasonable adjustments can include advice regarding physical changes to the building such as a ramp for someone for in a wheelchair, advice regarding altered working hours. For example, someone with panic attacks would be able to start and finish work at altered times to avoid rush hour. Other adjustments might include recognising someone with a chronic illness may require more time off work than someone who was fit and healthy. It is important to note here that occupational health provides an opinion and advice ONLY. It is up to the employer to decide whether they wish to follow the advice offered. More information can be accessed in Competency 5.
- Helping students in training. Here an OHP can provide advice and support to students at both undergraduate and post graduate level. This support applies to both physical and mental issues. Occupational health advice can be accessed via the student services or hospital trusts depending on the student’s position in training. An example would include managing and monitoring a student who has a drug or alcohol problem or who is depressed. Whilst the OHP will not clinically provide treatment, he/she can look at work factors to help support the student seek help. The OHP can act as a liaison between student and deaneries and provide advice to deaneries regarding such issues as student placements closer to centres of treatment, modifications of work loads, as well as referring the individual to appropriate agencies. It is again important to recognise the OHP can provide advice only to the deaneries and trusts regarding support. The decision to follow the advice lies with the deaneries and/or the trusts.
Multidisciplinary work might involve working with other specialties such as Public Health or the Health and Safety Executive when considering population based issues or with physiotherapists, counsellors or human resources when considering individual cases.
Consider the management of an outbreak of campylobacter in a food factory.
- The role of the occupational health physician is to liaise with the HSE, Public health and factory to ensure and manage the outbreak within the factory effectively.
- The Public Health Consultant’s role in general is to produce and implement policies and practice to maintain the health and well being of the local population. In the example of the factory with the outbreak of campylobacter their role would be to restrict and investigate the spread of disease as well as ensure public safety.
- Health and Safety Executive (HSE) as outlined in pages 2 & 3 in the fifth competency is an enforcing authority for the Health and Safety Commission. The HSE inspector has a responsibility to monitor the health and safety in factories and high hazard employment such as railways, nuclear, off-shore, mines, quarries, hospitals and schools. In this particular example, the HSE inspector needs to investigate if health and safety regulations have been breached and provide subsequent recommendations.
Consider now some further scenarios which explore other areas of multidisciplinary working.
A nurse who works on a medical ward has been referred to the hospital’s occupational health department with a reoccurrence of back pain. She has been absent from work for 4 weeks and has been referred by her ward manager for advice regarding: her underlying medical condition, when she is likely to return to work and if anything can be done in the workplace to assist her recovery?
Who are the most likely members of the occupational health team to initially be involved with seeing this nurse and why?
- Clerical staff
Organise notes, arrange appointment and deal with any queries.
- Occupational Heath nurse
To take the nurse’s blood pressure, pulse, height, weight, and check urine.
- Occupational health doctor
To asses the nurses’ physical and mental state. To take a history, examine, evaluate functional limitations and formulate a management plan considering available options.
- Secretarial staff
Type reports and arrange any follow up appointments
What complementary services are available to the occupational health doctor to aid the return of this nurse back into the workplace and why?
For postural and muscle strengthening exercises.
- General Practitioner
For review and further management of the back problem.
- Manager/ Human resources.
To consider advice from the occupational health service regarding the consideration of temporary adjustments in the workplace to aid rehabilitation: altered duties and hours.
- Manual handling trainer
For advice on lifting and use of hoists/aids
- BackCare www.backcare.org.uk 
For provision of advice regarding back care.
In some industries there is a statutory obligation to provide regular health screening. Such industries are defined as ones where employees might be at significantly high risk to specific health hazards associated with their work e.g. ionising radiation, lead, or asbestos and there is a duty on the employer to provide regular screening by an ‘appointed doctor’ or a doctor employed by EMAS. An appointed doctor is a doctor who is recognised as having received training to a required standard in the health risks associated with a specified hazard.
A factory that produces lead batteries employs 30 individuals. Their health surveillance is being provided by an appointed doctor who visits the factory. As part of the regulatory guidelines for employees working with lead they undergo regular blood lead levels as well as pre-employment and annual medicals. Recent results show a general increase in the blood lead levels of most of the employees. This has raised concern in the appointed doctor who has asked to meet with the health and safety officer as well as the manager of the company.
What are the responsibilities of the appointed doctor in this situation?
- To the employees
The doctor’s primary responsibility is to the current employees who are exposed to an identifiable hazard.
- To the employer
To provide an independent professional service ensuring that health surveillance in terms of biological and medical monitoring of exposed employees is carried out to a satisfactory standard.
- To the Health and Safety Executive
Appointed doctors are required to inform the HSE if blood lead levels reach a certain value where by an employee needs to be removed from exposure.
What concerns may the appointed doctor have?
- Gradual increase in the levels of lead in the employees and the possible health implications related to this.
- That all measures to reduce exposure are being carried out: use of ventilation, wearing appropriate personal protective clothing, ensuring good personal hygiene, no smoking, eating or drinking on the factory floor.
- The employer’s understanding of the health and possible regulatory implications of persistent high blood level results.
- Changes to the working practices of the factory to account for rising blood lead levels.
What action plan may be drawn from such a meeting?
- Formal identification of hazards and risks.
This might be done by the occupational health staff working with the organisation’s safety officer and an occupational hygienist in walking through the factory and making a detailed assessment of the hazards, risks and control measures in place.
- Checking control measures
This might require the ventilation control measures in place being checked to assess their level of function
- Checking personal lead or, and lead in air levels.
- Checking working practices
It would be important to check the employees were using their personal protective equipment, adhering to personal hygiene – washing hands regularly, and not smoking, eating or drinking on the factory floor.
- Provision of advice and information to employees and employers to ensure their understanding of the hazards and risks involved.
What other services are available to the appointed doctor to help implement the action plan?
- Health and safety officer
The officer would assist in performing the walk through
- Occupational hygienist
The hygienist role would be to check the ventilation systems and perform lead monitoring in the workplace to help identify areas of raised exposure.
- Occupational health nurse
The OHN would provide advice, information and education to the workforce.
Why may the appointed doctor request support from other services?
- Lack of time.
- Lack of expertise and knowledge. It is important for a practitioner to recognise their own limitations and when they require support and help.
- Cost effective. It is more cost effective for an employer to pay for an occupational health nurse to provide advice, information and education than to pay a doctor for the same service.
The above 2 scenarios illustrate the fact that to provide an efficient and effective occupational health service it is vital for an occupational health doctor to be part of a multidisciplinary team. It is important to recognise one’s own limitations in terms of knowledge, expertise and time, with the need to seek help and advice appropriately.