SOM have prepared a paper on Long Covid and Return to Work – what works.

https://www.som.org.uk/sites/som.org.uk/files/Long_COVID_and_Return_to_Work_What_Works.pdf

BOHS calls on Prime Ministerial Candidates to end the national shame of asbestos deaths

From 1^st July 2022, fit notes can now be certified and issued by registered nurses, occupational therapists, pharmacists and physiotherapists, in addition to doctors.  In the Government guidance for employers^[1], the Department for Work and Pensions (DWP) makes clear that not all individuals within these professions will be suitably experienced and qualified to certify and issue fit notes, so will only do so where they have the relevant training and knowledge to make an assessment of a person’s fitness to work.

The organisations that form the Council for Work and Health include doctors, nurses, occupational therapists and physiotherapists, and other professionals with training and knowledge who can advise on health and work, and who can also advise on training for those now providing fit notes.

Unless they themselves are working in the NHS, doctors, nurses, occupational therapists and physiotherapists working in occupational health will not usually have access to paper or digital versions of the ‘Med3’, which is the form these health professions working in NHS primary care will use, or the F Med 10, which these professionals working in NHS hospitals may now use.  Other forms of medical evidence, including private medical certificates, occupational health reports and an Allied Healthcare Professionals Advisory Fitness for Work Report can be accepted as medical evidence in the same way as a fit note, subject to the employer’s agreement.  DWP go on to advise that in this instance the employer does not need to ask their employee to obtain further fit notes from their GP.

Other aspects of the guidance have not changed, but the following are areas in this guidance where over recent years we have come across some misunderstanding:

• The employee can come back to work at any time, even if this is before their fit note expires.  They do not need to go back to their healthcare professional first.

• The fit note belongs to the employee and they should keep the original.  The employer may decide to take a copy for their records (this is usual).

• People do not need to be signed back to work and there is no option on the fit note to do so.  If the employee’s healthcare professional assesses that they are fit for work, they will not be issued with a fit note.

• For a limited number of jobs, there are separate procedures to ensure someone is fit to carry out their role.  The HR, occupational health or legal department should know if this applies to the employer’s organisation.

• If the organisation has a separate policy which requires someone to obtain medical evidence that they are fit for work, this should be arranged through an occupational health specialist^[2].

• The fit note is not binding on the employer. The assessment about whether the employee is not fit for work or may be fit for work (and any other advice in the fit note) is classed as advice, and it is for employers to determine whether or not to accept it.   The employer is within their rights to gather other evidence about their employee’s fitness for work from other healthcare professionals (such as an occupational health professional). The employer can choose to give this other evidence precedence over the advice in the fit note.

• For complex or possible work related conditions, support from occupational health specialists should be seriously considered.

• For more information, the employer could consider advice from an occupational health specialist.  The employer can also write to the treating healthcare professional for more information, although they may have to pay for this service and healthcare professionals may not be able to respond immediately.

[1] Guidance for employers on the fit note (updated 1 Jul 2022) at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers

[2] Government guidance on the further support provided by occupational health services at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers/getting-the-most-out-of-the-fit-note-guidance-for-employers-and-line-managers#further-support

The Government have announced today (13 June 2022) that with effect from 1^st July 2022 legislation is being introduced across Great Britain that will allow more healthcare professionals to certify fit notes to patients. Information on the Fit Note can be found at: https://www.gov.uk/government/publications/fit-note-guidance-for-employers-and-line-managers/getting-the-most-out-of-the-fit-note-guidance-for-employers-and-line-managers

Currently only doctors can legally certify fit notes, but the Department for Work and Pensions (DWP) is now changing the legislation to allow a further four professions to do this.  These professions are nurses, occupational therapists, physiotherapists, and pharmacists.

The Council for Work and Health welcomes this move.

We would also endorse the comment that has been made by DWP that not everybody working within these professions should issue fit notes.  We agree that health professionals providing fit notes should be working in a suitable environment and have the necessary skills and training to have work and health conversations with patients.  This task needs to be within their professional scope of practice, and we note that new guidance and training has been developed which will help professionals to identify if this task is suitable for them.

The Council will be pleased to offer guidance on appropriate training and other advice for these groups of professionals who may now be in a position to offer advice on fitness for work.  The Fit Note represents the first line of advice; professionals represented within the Council’s membership are able to provide more specialised and a breadth of advice to employers on fitness for work.

The Council brings together the bodies which represent the wide range of professions that deliver health, safety and wellbeing services at work, as well as other bodies with a close interest in health and work, which include DWP.  The Society of Occupational Medicine (SOM) and the Faculty of Occupational Medicine (FOM) are  members of the Council, whose membership includes most doctors working in occupational medicine practice.  The Council also has representation from the Royal College of General Practitioners (RCGP).  The Council includes those bodies representing the health professionals who as well as doctors will now be able to sign Fit Notes, including the Royal College of Nursing (RCN), the Faculty of Occupational Health Nursing (FOHN), the Association of Occupational Health and Wellbeing Professionals (iOH), the Royal College of Occupational Therapists, the Chartered Society of Physiotherapists and the Association of Chartered Physiotherapists in Occupational Health and Ergonomics (ACPOHE).

We would highlight that there are many other health professionals that make a substantial contribution to health and work, also represented on the Council.  These and the other bodies with a close interest in health and work are detailed on the members page of our website at: https://www.councilforworkandhealth.org.uk/about/our-members/

https://www.councilforworkandhealth.org.uk/wp-content/uploads/2022/04/Vocational-Rehabilitation-BSRM-brief-guidance.pdf

Council for Work and Health guidance for employers as of 8 July 2021

Working safely during the COVID-19 pandemic as community restrictions ease.

As set out in their guidance at: https://www.gov.uk/government/publications/covid-19-response-summer-2021-roadmap/covid-19-response-summer-2021, the Government have announced that they intend to remove all legal restrictions to stop the spread of COVID-19 in England from 19 July 2021. This does not however change the employer’s responsibilities to provide a safe place of work.  In this guidance the Government have made clear that “Working Safely: guidance will be updated to provide examples of sensible precautions that employers can take to reduce risk in their workplaces. Employers should take account of this guidance in preparing the risk assessments they are already required to make under pre-pandemic health and safety rules”.

The Council for Work and Health, comprises members from the broad range of organisations involved in health and work.  The aim of this briefing note is to provide guidance to employers on how they can protect the health of employees and others affected by the activities of their organisation, in the context of rising levels of COVID-19 infection in the community, and the potential disruption to business continuity through loss of manpower through self-isolation.

Whereas the requirement for self-isolation for contacts who are double vaccinated and children is to end from 16^thAugust (at: https://www.gov.uk/government/news/self-isolation-to-be-eased-for-fully-vaccinated-adults-in-step-4), there are likely to be significant numbers of employees unavailable due to existing legal requirements to self-isolate following notification by NHS test and Trace that they are a contact (at: https://www.gov.uk/guidance/nhs-test-and-trace-how-it-works).  Keeping transmission of infection in the workplace as low as possible will promote health of the workforce, and the business.

The Health and Safety Executive (HSE) guidance on making the workplace COVID secure is the principal reference, at: https://www.hse.gov.uk/coronavirus/working-safely/index.htm.  HSE intend to update this guidance on 19^thJuly, but the following principles would endure:

We recommend all employers review their workplace risk assessment, to review known hazards and to identify new potential hazards to health, and any change in the likelihood of employees and others coming to harm as a result.

Hazardsinclude a biological hazard, COVID-19, and specifically the Delta variant causing the current third wave, and which is known to be more transmissible than the Alpha variant dominant until now.

In considering those who may be more vulnerable, employers may have taken advice from occupational health professionals on those people who may be more vulnerable to COVID-19.  Factors increasing risk of individuals coming to harm if infected include age, gender, ethnicity, obesity, and health conditions the evidence shows increase vulnerability, and particularly in combination.

There are also potential psychological hazardse.g. from those who have been working from home during the pandemic anxious about coming into the workplace, or those in public facing roles.

In the context of risk assessment, it is important for employers to consult with employees and/or their representatives. Where feasible coproduction of this risk assessment is likely to identify the potential hazards and the associated risk, for employees, and others affected by the organisation’s activities.

Having considered hazards and the risk posed by these hazards, risk management controls should be reviewed. These are best considered within the “hierarchy of controls”.  We are pleased to note that the Government are adopting this approach in their guidance, for example updated guidance on risk assessment for schools at: https://www.gov.uk/government/publications/actions-for-schools-during-the-coronavirus-outbreak/annex-a-health-and-safety-risk-assessment:

1. Elimination. To stop an activity that is not considered essential if there are associated risks.
2. Substitution. Replacing an activity with another may reduce the risk. e.g. home working. It is important to note that substitution can create another risk, and there are mental health implications that have been seen through isolation over this last year or so. There are also physical hazards, and we have seen significant numbers of people who have work-related upper limb disorder due to unsuitable display screen equipment workstation setup at home.
3. Engineering controls. These are ways to design out risk, or to use physical means to separate people from source of the risk. This will also include ventilation, fresh air being important to reducing the amount of virus that is in the air that people breathe in workplaces.
4. Administrative controls. These include making space between people, and although the Government is likely to remove the legal requirement for social distancing, employers may consider whether it is necessary to have all employees within the office at one time. Keeping occupancy in the workplace below pre-pandemic levels will reduce the risk of transmission, and so reduce the likelihood of employees being infected in their work, or when commuting to and from work.
5. Personal protective equipment. With the legal requirement to wear face coverings in shops and on public transport likely to be ending, businesses can still decide whether their employees should still wear masks or other PPE in the workplace. They also may require those visiting the premises wear to face coverings where risk assessment and control measures cannot reduce risk as low as reasonably practicable. In healthcare and in care homes, this is likely to remain a requirement in these settings for the foreseeable future.

Testing. Testing is an administrative control. Employers may consider introducing twice weekly rapid home testing if they are not already doing so.  Employees can order lateral flow device (LFD) tests through the Government website at: https://www.gov.uk/order-coronavirus-rapid-lateral-flow-tests. By taking an LFD test before coming to work, this allows those people who are infected, but do not know it, to avoid infecting others.  Positive or negative results should be reported whether positive or negative each time at: https://www.gov.uk/report-covid19-result. And of course, those who have symptoms must self-isolate, and obtain a PCR test as soon as possible. Those testing positive on LFD testing should also self isolate and obtain a PCR test as soon as possible (as at: https://www.gov.uk/get-coronavirus-test).

Immunisation.Immunisation may also be seen as a risk management control. The evidence shows that the vaccinations currently in use in the UK remained effective against the dominant Delta variant, although both doses are needed to gain maximum protection (as reported on 8 Jul 2021 by the REACT study at:https://www.gov.uk/government/publications/react-1-study-of-coronavirus-transmission-june-2021-interim-results. Being double vaccinated may therefore allow those who are more vulnerable to work in a public facing role, together with other risk management controls that the employer considers appropriate following risk assessment.  However, we do not know as yet whether being vaccinated substantially reduces the risk of passing the infection onto others. Therefore until otherwise, those who are vaccinated must still “follow the rules” in the community, and in workplaces.

Communication and training. It is essential that all staff are fully aware of the rationale for the risk management controls. The effectiveness of controls may be enhanced through coproduction where this is appropriate, but consultation with employees and/or their representatives is always needed.

Review. Risk assessment and controls should be reviewed at periods that the employer determines, and specifically when the situation changes.

Professional advice.  Advice on keeping risks to health in the workplace as low as reasonably practicable may be obtained through providers of occupational health and safety services, and from human resources, workplace mental health providers and other professionals represented by the broad range of members that form the Council for Work and Health at: https://www.councilforworkandhealth.org.uk/about/our-members/.

Council for Work and Health statement on Long Covid

For people with Long Covid, there needs to be workplace support for return to work.  There needs to be sustained joined up services to assist people with Long Covid who are at work to stay at work, through medical, biopsychosocial and workplace support and vocational rehabilitation.

Many employers have gone above-and-beyond to make sure their staff feel supported as the pandemic has unfolded, and this is essential for people with Long Covid who may benefit from slower graduated returns and ongoing accommodations due to their fluctuating symptoms.  Such support is the right thing to do after the pandemic but may also help organisations avoid talent leaving the workforce and even legal challenge.

We are particularly concerned about the impact of poor management support due to a lack of knowledge, skill and resources to effectively manage people with Long Covid.  Good line management of people with Long Covid is crucial. 

Employers have a duty of care to their staff and now more than ever, every employee with Long Covid needs to be treated with compassion, to be listened to and supported through difficulties that Long Covid presents with. 

As Long Covid is a new health issue, the patient perspective is particularly important e.g. with care taken on physical exertion until appropriate diagnostic tests have occurred.

The Council asks for evidence-based NHS services for people with Long Covid, across the nations of the UK that works with occupational and vocational rehabilitation specialists on return to work. 

The Council also wishes to ensure Long Covid is prevented, fundamentally by avoiding Covid-19 transmission. It notes the risk of workplace transmission at work.  The hierarchy of controls and effective risk assessments remain essential to keep the likelihood of exposure to COVID-19 as low as possible.

Resources:

• Our Members – Council for Work & Health (councilforworkandhealth.org.uk)
• Your COVID Recovery | Supporting your recovery after COVID-19
• Patient support groups e.g.  Home – Long Covid Support
• Return to work guidelines COVID-19 return to work guide: For managers | The Society of Occupational Medicine (som.org.uk)