As the ‘Decade of Action’ (2020-30) for the United Nations Sustainable Development Goals (SDGs) grows in urgency, what should it mean for occupational safety and health (OSH) and ensuring that allwork is good work? How do we best address the needs of a virus-affected world and the challenges and opportunities of the 4^thIndustrial Revolution, the digital and green economies, demographic and technological changes, and the future of work? How do we ensure that we revitalise our support systems and ‘build back better and healthier’?

Many of the SDGs relate to work and to OSH, as highlighted in the IOSH sustainability policy, particularly SDG Goal 3 ‘Ensure healthy lives and promote wellbeing for all at all ages’ and SDG Goal 8 ‘Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all’, which includes ending modern slaveryand human trafficking.

Importantly, as we’ve all witnessed, the Coronavirus pandemic has reinforced the intrinsic links between environmental, public, occupational and general health, as well as shining a light on health inequalities and the need to better protect health and social care workers and others on the frontline, and to ‘build back better and healthier’. This includes ensuring effective test, trace and isolate systems, and access to personal protective equipment, vaccines, therapeutics and ongoing mental health support. Central to delivering improvement is SDG Goal 17 ‘Strengthen the means of implementation and revitalise the global partnership for sustainable development’. This UN call for international capacity-building and multi-stakeholder partnerships to ‘mobilise and share knowledge’ is a clear request for stronger multidisciplinary working and for all health and health-related professionals to contribute.

This is where I believe the collective health community, professional bodies and networks have pivotal roles, both now and in the future. We need to see OSH / OH professionals increasingly harnessed to help public policymakersand organisations tackle the complex work-related health challenges, such as from climate change, air pollution and extreme weather; increased sedentarianism; extended working lives; the needs of workers with health conditions and disabilities; tackling communicable and non-communicable diseases at work; and the exponential growth in new workplace technology, automation and artificial intelligence.

We need to work together to ensure greater focus on human-centred public- and corporate-policy and on managing psychosocial risk at work, with mental healthfinally gaining parity with physical health, and stigma ended. And we need to collaborate to support diverse and inclusive workforces, protect vulnerable groups and embed OSH risk-intelligence as a key life- and employment-skill, essential to long-term social value and achieving SDG Goal 4 ‘Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all’.

Thankfully, in the decade ahead, I think we can expect to see better-informed public opinion continue to drive higher societal expectationsand requirements on organisations and leaders seeking new ‘social licenses’ to operate and govern. And also see improved performance evaluation and transparency increasingly sought by stakeholders wanting assurance, not only that no-one is being harmed by public policy or corporate activity, but that people’s health and wellbeing is actively enhanced in line with our more socially conscious world.

This demand for transparency and comprehensive corporate reportingwill help drive meaningful and comparable OSH performance reportingat global, national and corporate levels and recognition that good OSH must be a fundamental right worldwide. Professionals have key parts to play, fostering positive and learning cultures; designing-in OSHand evaluating interventions; developing meaningful indicators and utilising data; and making recommendations to improve OSH performance across regions, organisations and supply chains.

So, what key changes are needed to tackle the millions of work-related deaths each year, improve OSH and wellbeing and deliver on the SDGs? I believe they must include:

• Recognising OSH as essential to public and socioeconomic good, so that it is designed into all public-policy,global trade, international development and corporate strategies
• Building global OSH capacityand improving access worldwide, including for micros, SMEs, the self-employed, migrant and informal workers and all those on the frontline
• Harmonising and standardising meaningful OSH performance reportingto drive global, national and corporate decision-making and investment for prevention, emergency planning and improved OSH and wellbeing

To close, can I just urge that, as professionals, influencers and networks, we continue working together and reaching out to ensure that this decade is one in which the true value of OSH / OH is harnessed to support good work for all, healthier populations and sustainable futures.

If you’d like to know more and support IOSH’s advocacy work on ‘building back better and healthier’, please contact the IOSH Policy team at publicaffairs@iosh.com.

Richard Jones

IOSH

13 November 2020

Leadership in occupational health over the first wave

As the pandemic hit, time seemed to alter, and intensity increased. The pace of “leadership responsiveness” required multiplied. Suddenly, we needed to be “just in time” rather than the days or weeks that medical societies usually take.

The office team “disappeared” in March to work (very effectively) at home. A new, wider, team emerged beyond the Society of Occupational Medicine, of professionals from different disciplines and organisations.  Subgroups focused on PPE and mental health at work were formed. New communication channels opened with daily briefs, weekly webinars, and front-line networks.

Expert leadership was important. Occupational Medicine experts quickly called out the Government’s position on PPE standards and supply. But we knew little about Covid, for example in terms of transmission mechanisms. We quickly hosted a webinar with an Italian occupational medicine expert, ahead of the UK in terms of Covid impact, as to what they were experiencing in hospitals.

It was inspiring to see leadership elsewhere. As Covid-19 deaths tragically increased, a former Windsor Leadership Trust Alumni, and a former President of the SOM, David McLoughlin kept me in touch as to the military’s amazing work setting up the Nightingale Hospitals. Many occupational health professionals working in the private sector volunteered to work in the NHS. NHS England put in place procurement to support NHS occupational health teams.

In April, we decided to move to proactive challenge and focus on the occupational health risk of health care professionals. Dr Will Ponsonby, the SOM President, publicly rejected the Government’s rhetoric of professionals on a front line “war”. Instead we campaigned with the BMA and others “that no health care worker should die of Covid transmission” if proper controls are in place. Amnesty International subsequently produced a report highlighting this issue[i].

In the middle of this, a refreshing culture emerged ofleadership that was still about rationality, objective truth and weighing up the evidence but also about warmth, collaboration and energy (although energy was hard to maintain when it was all online).

With the end of the initial lock down in sight, we focused on the risk of return to work. A collaborative, leadership style continued with new partnerships emerging. We achieved in weeks what would previously have taken months with organizations such as Mind, CIPD, BITC and Acas to offer advice and toolkits. And, even with the frenetic pace of activity, we found out a bit more about each other and our solaces (in my case re watching a lengthy BBC Programme about a shepherd taking Herdwick sheep off a hill).

Despite our new confidence of working with trusted partners, with the launch of effective new advice and “toolkits”, we struggled to influence.  Government was in an emergency “command / control mode”. Responses from the “Centre” on key issues were delayed or not forthcoming. It felt a bit Vicky Pollard … “yeah but no but yeah”.

Some things we did not get right. I regret not reacting to data that emerged showing that some occupational health groups such as minicab drivers and security guards were more at risk of dying from Covid. We must highlight the inequality that Covid is creating and avoid a “white collar” prejudice at the expense of those working in low income public facing roles or factories such as in meat packing who have a higher Covid risk.

In July we launched a new report on the mental health of nurse and midwives, but like many by the end of July, I needed a break. Zoom calls blurred into one and it was hard differentiating online with real life. I needed to practice what I preach in our “mental health in the workplace toolkit” and take a break.

In September, we started again with the confidence that we have a social purpose to make a difference to workplaces.  We were profiled in New Scientist magazine. However, pressures quickly started again though in terms of questions on testing and how any vaccine would be delivered.

Questions remain. In terms of risk, one risk of Covid transmission can be reduced in place of another in terms of the health risks of unemployment. We are hosting, with partners, a summit on this on 10^thNovember (at https://www.som.org.uk/civicrm/event/info%3Fid%3D313%26reset%3D1)

It is important to celebrate success (with an awards process for innovators who have come up with tools such as the “Covid Age” next month). We need to support current and future leaders through mentoring and peer support. We should be offering leadership training to those occupational health individuals who have the potential to become our leaders of the future. We are actively looking for funding for this.

We now need to pace ourselves for the winter…

[i]https://www.amnesty.org.uk/press-releases/uk-among-highest-covid-19-health-worker-deaths-world

Nick Pahl

Long-term Furloughs During COVID-19 Hold Risks for Employee Health and Wellbeing

By Carol Black and Christian van Stolk

Governments around the world have offered furlough schemes to try to delay employers from making any restructuring decisions during the COVID-19 crisis. The public purse covers a specific percentage (80 per cent in the UK) of a salary up to a certain level (typically the average annual wage in an economy). Employers then have the option to top up this wage.

An estimated 25 per cent of UK workers are now part of the government furloughing scheme, which has been extended until October. Employers will be asked to contribute pension payments and national insurance from August and a larger salary share from September.

The aims of such programmes are laudable. They may, however, come with unintended consequences. Two reviews for the UK government, Working for a Healthier Tomorrow and Psychological Wellbeing and Work, suggest the importance of ensuring that employees in furlough schemes stay connected to work and the need to look after the mental health of the workforce.

Currently, employees are not allowed to work at all while they are part of the furlough scheme. We know that an employee who is away from employment for a period of about six weeks becomes deconditioned — in effect, less likely to return to employment. At that point, an individual is more likely to enter the benefit system.

Furloughed individuals also may lose touch with the workplace altogether. They may be less likely to access the occupational health provision or health and wellbeing programmes offered in many workplaces. People could become cut off from some of their normal support networks. Without these networks, relationships at work could break down, and as a result, a fundamental part of an individual’s social fabric.

Moreover, mental health tends to deteriorate when people lose their sense of social purpose. This sentiment may become more prevalent among people who are on furlough schemes where they may feel that they are kept out of work artificially or face delayed unemployment. Mental health is already a concern in the present crisis, in which general uncertainty is coupled with the disruption of routines at both home and work.

This matters. Evidence tells us that those with common mental health conditions such as anxiety and depression are much more likely to be out of work or find it difficult to maintain a job. They are the most common conditions among those claiming out of work benefits, with 50 per cent of claimants typically reporting it as a primary or secondary health condition.

Even if workers maintain their employment, there may be significant challenges to their health and wellbeing arising from the crisis. Most employees have seen rapidly and profound changes to their working patterns including new forms of remote working, flexible working, social distancing at work and increased shift working. Many have had to combine work and caring responsibilities more than before.

The mental health of many workers likely will worsen over the coming months. Before the COVID-19 outbreak, one in six working-age people in England had a mental health problem. The prevalence is higher for younger workers, who are especially at risk of losing their employment in this crisis.

There is a need to look at how to support all workers with their mental health. This need is greater for the self-employed and smaller businesses, which employ most of the UK workforce but may not have the resources to support their employees at this time. Supporting the mental health of employees requires employers and governments to provide access to occupational health and NHS support at a time when social distancing is perhaps limiting service provision. It is important to find space on the policy agenda for this.

It is heartening to see that the UK government is allowing part-time employment in its furloughing scheme from July, be it with employers paying fully for the hours worked. However, it may be advisable for governments to incentivise employers to stay connected to their workforce by allowing part-time working sooner and even subsidising it. They could also allow keeping in touch days while people are in the furlough scheme.

A broader priority for government and employers in this crisis should be to invest in the health and wellbeing of all workers, especially in mental health. This could help avoid workers losing employment, remaining in the benefit system longer and lowering the long-term productivity among those at work. One of the main legacies of the crisis should be an appreciation of the importance of good employee health and wellbeing.

Prof Dame Carol Black is a physician who has over the past 14 years advised government departments and arm’s-length bodies on work, health and wellbeing. RAND Europe executive vice president Dr. Christian van Stolk has conducted extensive research on health and wellbeing in the workplace.

Informing risk assessment for those employees who may be more vulnerable to COVID-19

Robin Cordell, Director, Council for Work and Health

Our experience as occupational health clinicians over this last few weeks has revealed understandable anxiety among employers, employees and their families over the risk to those employees considered to be more vulnerable if they were to contract COVID-19.

Towards the end of March it became clear in published Government policy (now updated as at 1 May) at:https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-othersthat among those considered more vulnerable, which is broadly similar to those who have a ‘flu’ jab under NHS arrangements due to specified health conditions, there are those who are considered to be extremely vulnerable.

People in this very high risk group, about 1.8 million people, have been advised by the Government to be “shielded”, as at: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

Therefore there are three groups of people identified by Government in terms of the level of risk of a serious outcome.

At the top end of the scale, those at very high risk, who have been told they must not leave home for 12 weeks (or longer if the Government advises this).

The largest group is those at the standard level of vulnerability for the population as a whole.  The whole population are required to follow the enforceable measures introduced on 23 Mar 2020, as at: https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others/full-guidance-on-staying-at-home-and-away-from-others.  These social distancing measures include working from home wherever possible.

There is a substantial group in the middle, who have conditions that make them more vulnerable, and so are at increased risk, but who do not have the health conditions that make them extremely vulnerable and at very high risk of a serious outcome if infected.

Employers will all know that (at: https://www.hse.gov.uk/workers/employers.htm#) they have a legal duty to protect the health of their employees, and other who may be affected by their activities.  Employers must do whatever is reasonably practicable to achieve this.

Some employers have directed all employees who are more vulnerable to remain at home.  This is an effective social distancing measure, and will enable organisational outputs to continue if these employees can work entirely from home.

However, many organisations are engaged in essential work that cannot be done from home.  This includes healthcare and social care workers, those in local authorities, working with the most vulnerable people in society and providing essential services, and those in logistics. A risk management based approach has been undertaken by these clients.  Occupational health clinicians can advise on the vulnerability of their employees, and to suggest how the increased risk in more vulnerable individuals might be mitigated. Government provides guidance to employers on social distancing in the workplace at: https://www.gov.uk/guidance/social-distancing-in-the-workplace-during-coronavirus-covid-19-sector-guidance

Following referral by clients, a short occupational health teleconsultations is undertaken with employees followed by a short report is sent (with consent) to the employer.

The outcome of these assessments is tailored advice, given the employee’s individual health conditions and work circumstances, in order to inform the employer’s risk assessment.  We have found that “shading” the level of vulnerability within the more vulnerable group has been helpful, as our experience is that some in this middle group are more vulnerable than others.  We now use a GREEN-YELLOW-AMBER-RED risk indicator.

The following risk management table is based on Government guidance on social distancing at,and professional consensus documents, including those provided by the Faculty of Occupational Medicine (FOM), the Royal College of Obstetricians and Gynaecologists (RCOG).  Assessment of ethnicity as a risk factor is also included, in view of the observed disproportionate number of deaths among those of BAME ethnicity as at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30922-3/fulltext,.

Robin Cordell, Director, Council for Work and Health

Testing for COVID-19 infection and for immunity

Robin Cordell, Board Director, Council for Work and Health

Why is testing useful and what types of test are there?

Testing for COVID-19 is likely to significantly enhance risk assessment and management:

• To inform risk assessment to determine if key workers who have had symptoms of COVID-19, or whose household contacts have symptoms, can be in work. At present, any person with symptoms needs to self-isolate for 7 days, or if they have no symptoms but live with someone who does, they have to self-isolate for 14 days as at: https://www.gov.uk/government/publications/covid-19-stay-at-home-guidance/stay-at-home-guidance-for-households-with-possible-coronavirus-covid-19-infection
• In time, once testing for immunity is available, to allow greater certainty that individual employees are immune to COVID-19 and safe to be in work, with a much reduced risk of getting the infection themselves or of passing this on to others.

There are two types of tests.

• The Antigen test, a laboratory test, looks directly for the virus’s genetic material (RNA) through a process termed polymerase chain reaction (PCR).
• Antibody tests are currently being evaluated, which look for evidence that the person has been exposed and has immune antibodies to the virus.

Antigen testing

Testing for presence of the coronavirus (the antigen test) in those self-isolating at home with symptoms has now been extended to all essential workers (as defined at: https://www.gov.uk/government/news/coronavirus-testing-extended-to-all-essential-workers-in-england-who-have-symptoms).

Eligible workers (or their household contacts with symptoms) include:

• all NHS and social care staff, including hospital, community and primary care, and staff providing support to frontline NHS services (for example accommodation, catering) and voluntary workers
• police, fire and rescue services
• local authority staff, including frontline benefits workers and those working with vulnerable children and adults, victims of domestic abuse, and those working with the homeless and rough sleepers
• defence, prisons and probation staff, and judiciary
• other frontline workers as determined locally or nationally, including critical personnel in the continuity of energy, utilities and waste networks, and workers critical to the continuity of essential movement of goods

Those eligible and with symptoms of a high temperature or new continuous cough and would like to be tested for the virus should speak to their employer.  The process for getting tested is at: https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested.

As well as regional testing sites, where most people will have appointments, and increasing numbers of home testing kits, 100 mobile units run by the Armed Forces are now available for essential workers who work in more vulnerable settings, as at: https://www.gov.uk/government/news/mobile-coronavirus-testing-units-to-target-frontline-workers

A note of caution – no test is 100% reliable

Testing for presence of the virus will make a significant contribution to risk assessment. It is considered that sensitivity (picking up the presence of the virus) of the PCR antigen test is at most 90%. This means though that of 100 people tested who actually have the virus, at least 10 will test negative; a false negative.  Therefore having a negative test does not necessarily mean the individual does not have the virus, and is safe to go back to work.

We recommended that employees be asked to contact the occupational health provider as soon as they have the test result, whether this is positive or negative for the virus.

An occupational health clinician can then call to help the employee in their return to work, depending on the test results and any symptoms they still have.  Following this they can be certified as fit to return to work, or not fit pending further occupational health review if this is needed.  It is possible some people will need to be tested again.

Antibody testing (for immunity to the virus)

The antibody test is a blood sample (finger prick) applied to a reagent strip with immediate result and is being manufactured in high volume. This device is expected to be suitable for wider community use, once reliability is confirmed.

The Government’s specification for antibody devices is to accurately and reliably measure the presence of IgG (longer term response) antibodies to the virus, indicating infection at least 2 to 3 weeks earlier. Some devices also measure IgM (immediate immune response) antibodies, present for up to 3 weeks after infection.

At present there are no antibody tests sufficiently reliable to safely inform decisions on risk assessment. Development of these tests is a key element (Pillar 3) of the Government’s strategy at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878121/coronavirus-covid-19-testing-strategy.pdf.

Testing strategy and plan for your organisation

We suggest teleconference meetings between clients in sectors prioritised for testing and occupational health to discuss how this may be implemented in their organisation.

This will be to consider how antigen testing will be done for essential workers and/or their household contacts with symptoms (within the first three days of onset), in accordance with Government policy, and for all clients, how antibody tests will be accessed and the results used in future, once those shown to be at least 98% reliable are available.

Dr Robin Cordell, Director, Council for Work and Health