Health Screening
It is generally accepted that a company’s employees are one of its most valuable assets. It is therefore somewhat surprising that companies do not take as much care of their employees as they do of their other physical assets.
The Confederation of British Industry, in a recent publication ‘Business and Healthcare for the 21st Century’, highlights a direct cost to UK business of £11 billion a year due to sickness absence, as well as costs to society of nearly £23 billion a year. This equates to £500 a year for every employee in the UK. The Trades Union Congress, in ‘Restoring to Health, Returning to Work’, has called on the Government to give employers a legal duty to develop a rehabilitation policy as part of their health and safety policy. This is seen as the only way to achieve the 30% reduction in sickness absence caused by work, as identified in ‘Securing Health Together’, the 10-year national occupational health strategy of the Health and Safety Commission.
Caring for the health of employees through proactive health screening is currently, and rightly, high on the national and political agenda. The occupational health practitioner (OHP) is uniquely placed to support management who seek to act on this priority.
This article describes the fundamental elements of proactive health screening in the workplace.
WHAT IS EFFECTIVE HEALTH SCREENING IN THE WORKPLACE?
There are three fundamental elements to effective health screening in the workplace, assuming that the employer has already taken the necessary actions to ‘engineer out’ or minimize any risk to employees’ health. These three elements, supported by appropriate policies, are:
- pre-employment screening
- targeted health screening (health surveillance and periodic screening)
- sickness absence screening.
It is advisable for all employees to undergo pre-employment medical screening. As an absolute minimum all employees should be asked to complete a detailed medical questionnaire. This should be reviewed by an appropriately qualified OHP who would then determine whether the individual is capable of fulfilling the role and task requirements of the job. For individuals who will be asked to undertake physical work and/or will be exposed to specific work hazards, it is recommended that they undergo a detailed medical examination. A good baseline medical which, in addition to the questionnaire, would be applicable to most work environments would include:
- height and weight
- blood pressure and pulse
- urinalysis
- audiometry
- lung function
- vision testing.
In addition, where specific hazards are known to be present (chemicals, coal dust, asbestos etc) extra medical procedures such as a chest x-ray and blood tests would, as appropriate, be included.
The principal objective of a pre-employment medical is to ensure that the individual does not possess an existing medical condition which will prevent him/her from carrying out the normal duties of the proposed employment. Obviously, any discovered health problems will need to be considered in the light of the Disability Discrimination Act. In addition, the pre-employment medical provides baseline medical results against which subsequent results can be measured.
Targeted health screening
This includes health surveillance, a statutory requirement, and periodic screening, an aspect of good occupational health practice used to monitor an employee’s operational fitness, particularly where the employee is involved in safety sensitive work activities.
Health surveillance
Health surveillance is an area where, in general, companies fail to meet their obligations. Having commenced work it is the employer’s obligation to carry out periodic health surveillance for those individuals who are exposed to hazards as defined by Regulation 6 of the ‘Management of Health and Safety at Work Regulations’ (the Management Regulations). This is to ensure that the individual’s health is not adversely affected by the environment in which he/she works. It is worth pointing out that health surveillance is an integral part of a company’s risk-management strategy. In essence, it confirms that the control measures that have been put in place are working effectively.
Health surveillance as required by the Management Regulations can be relatively easily determined by reviewing the risk assessments and preparing a ‘targeted health surveillance matrix’. This matrix would include every individual, alongside which would be displayed their occupation together with any specific hazards to which they are exposed. The completed matrix would be reviewed by an appropriately qualified OHP who would determine what medical procedures should be carried out and the frequency.
In relation to health surveillance, excellent guidance already exists within the quarrying industry and attention is drawn to the Quarry Products Association’s ‘Health Surveillance Guide’. The HSE publication ‘Health Surveillance at Work’ is also recommended reading.
Periodic screening
In addition, for specific occupations (fork-lift truck drivers, emergency services etc) a routine medical is recommended to ensure ongoing operational fitness and these requirements may be conveniently built into a targeted health surveillance matrix.
Sickness absence screening
All companies should have in place a policy for proactively screening employees absent from work through sickness, facilitating early intervention and a return to productive employment.
In its simplest form this could be a telephone call to the individual, by his/her manager, to ascertain what assistance, if any, he/she requires. In other cases contact with the individual’s general practitioner may be of assistance. In this relatively simple way the employee is made aware that the company is concerned about his/her well-being and is interested in seeing that he/she returns to work at the earliest opportunity.
Unfortunately, such early and ‘friendly’ intervention does not routinely occur and as a result there is potential for animosity to build up between the employee and the employer. The employee thinks that the employer is not interested and does not care, while the employer thinks that the employee is a ‘time-waster’ and not interested in work.
In addition, the relatively simple steps mentioned above are often helped by the involvement of an OHP. These individuals can independently review each case from both the employee’s and employer’s perspective but with the overriding consideration of facilitating the early return to work of the employee. The OHP should have detailed knowledge of the workplace and the employee’s medical history and current health problems. With all this information the OHP can advise management and the employee on the appropriate way forward, including the possibility of a structured return to work under an agreed rehabilitation programme.
In some instances the OHP will suggest to management that the individual be referred to a specialist for specific help. This referral process could involve an appropriate fast-track referral, for example to a physiotherapist, counsellor or medical specialist.
The crucial issue in sickness absence management is early intervention so that each individual case can be managed to avoid lengthy absence and the probability of the employee becoming ‘domestically institutionalized’. This is particularly true with mental health issues, such as stress, and musculoskeletal conditions, such as low back pain. In the case of low back pain evidence-based guidelines have been published by the Faculty of Occupational Medicine.
THE CLAIMS CULTURE
The issue of employee claims has deliberately been avoided in this article. Clearly, if companies have in place proactive healthcare screening, as discussed above, the likelihood is that under such a regime fewer claims will arise and those that do will have been properly managed and any resul-tant damages will be minimized.
SERVICE PROVISION
Finally, in terms of selecting a service provider, it is imperative that the provider has the appropriate expertise and professional qualifications. The Faculty of Occupational Medicine (tel: 020 7317 5890), the Society of Occupational Medicine (tel: 020 7486 2641), the Association of Occupational Health Nursing Advisers and the Society of Occupational Health Nursing Advisers are the main bodies dealing with occupational health practice in the UK and can provide guidance on selecting a suitable service provider. The Employment Medical Advisory Service of the Health and Safety Executive can also provide local advice.
BIBLIOGRAPHY
‘Business and Healthcare for the 21st Century’, CBI, London, 2000.
‘Restoring to Health, Returning to Work’, TUC, London, 2001.
‘Securing Health Together. A Long-term Occupational Health Strategy’, HSC, London, 2000.
‘Management of Health and Safety at Work Regulations, HSC, London, 1999.
‘Health Surveillance Guide’, Quarry Products Association, London.
‘Health Surveillance at Work’, HSE, London, 1999.
‘Occupational Health Guidelines for the Management of Low Back Pain at Work’, Faculty of Occupational Medicine, London, 2000.
The author, Dr R.M. Quinlan, is medical director of Business Healthcare Ltd
