Discussion Paper – Work in Progress

Collaborating to Improve Health in the Working Years

Situation

Healthy Working Lives (HWL) is a mature national health improvement programme, operational since 2006. NHS boards deliver the programme within their areas complemented by a national team from Health Scotland.

To address inequalities in Aberdeenshire, NHS Grampian HWL has focused on business sectorswhich in the past have not engaged with HWL and are likely to have a workforce which will include employees at the lower end of the pay spectrum.HWL has targeted two sectors in North Aberdeenshire - agriculture and fish processing- as a pilot, over the last year to capture learning about how we best engage and support SMEs.

Our focused reveals potential misconceptions about industries' needs in relation to inequalities in health, disinterest and lack of traction, and factors which, even with the best will, can derail carefully agreed plans.

Background

The Scottish Centre for Healthy Working Lives (SCHWL) is the national centre of expertise in Scotland on improving the health of those in work, particularly thosemost at risk of preventable ill-health.NHS Grampian (NHSG) works in partnership with the Centre, providing HWL support and advice locally.

The principal focus of HWL is working with employers to enable them to understand, protect and improve the health of their employees. This is done through a range of customer-focused solutions and services. The programme is targeted at adults from 16 yrs to retirement. A key aim is to work closely with small to medium enterprise companies (SMEs).

National Performance Indicatorsfor this workinclude the number of employers: accessing services,represented at training and awareness sessions, supported in detecting health, safety and wellbeing issues, engaging with multiple services, and, supported in developing policies. NHSG is on target for each indicator.

NHSG works with approximately 150 companies throughout the North East,to facilitate a planned, integrated approach to improving the health, safety and well-being of employees.Oil and Gas related organisations account for approximately 53% of theclient base. Pay scales within Oil and Gas are acknowledged to be generally above the national average. However, it is clear from the organisational profiles that many businesses also includeoutside contractors. Generally, this section of the overall workforce does not enjoy the same contractual conditions as the main operator, and includes less well paid employees, for example in catering and cleaning.

Reducing health inequalities is afundamentalcommitment,nationally and locally. NHSG is prioritising the national HWL guidance to engage with employers with more than 30% of their workforce earning low pay, defined nationally as earnings below the Living Wage (£7.85 per hour)[i]. Close working with the industries chosen, however, has revealed a more complex picture. For example, within the agricultural sector, an industry with a well evidenced range of health risks (Annex A),many are self-employed, taking no ‘wage’, often no holidays and engaging family members for support at no cost.

Research findings (Scott Porter, 2014)[ii] indicate that safety issues remain the priority for all businesses, particularly micro and small ones. Scott Porterindicated that the majority of SMEs were complacentabout health issues, beyond those driven by compliance. Generally, there was a ‘deal with it when it arises’ attitude. The service and primary sectors reported least activity focusing on health and wellbeing of employees.Our experience suggests this is the picture within agriculture.

We reviewed our overall approach to working with employers to reduce health inequalities. A reviewof relevant literature[iii]informed our decision to support the SMEs in agriculture and fish processing with a view to enablingthem (and their trade associations) to address health, safety and wellbeing of their employees, and to play their part in making Aberdeenshire healthier, wealthier and fairer.

Aim

We resolved to engage employers in such a way that we might co-produce ways of working, within the overall framework of the national HWL programme.We would offer to support employers with issues ranging from health and safety, to how employers might develop a policy to reduce days lost through alcohol or drug misuse for example, promoting their role as a good employer enabling their employees to look after their own health.

The work has been pathfinding, to support cultural shift, capacity and leverage to improve health and reduce inequalities through the workplace. The pathfinder has concentrated on business sectors which in the past have not engaged with HWL and are likely to include workers towards the lower end of the pay spectrum.

Previous local research had not identifiedlevels of awareness of Healthy Working Lives or attitudes and understanding of ‘good work’amongst SMEs in either the agricultural or fish processing sectors in Aberdeenshire. Most importantly, both sectors have a wide range of work associated risk factors

Initial work again revealed that the HWL programme proxy for inequality - a threshold of 30%of employees on or below the Living Wage is something of a blunt instrument*.For example, wages vary considerably in fish processing. At times they may be high, dependent on size of catch available for processing and level of skill of employees, with payment by weight of fish filleted.

Our intention at the outset was to share ourexperiencewith Aberdeenshire and Aberdeenshire Community Planning Partnershipand encourage partners’ engagement in adding value to the collective effort in Aberdeenshire to improve health and reduce inequalities in the workplace.

Our focused work in North Aberdeenshire would enable us to:

  • Define and implement an engagement strategy which better reflects the needs of the two sectors targeted vizagriculture and fish processing
  • Align and refine the approach and products of the HWL team to most effectively meet those needs.
  • Assess customer response to - and satisfaction with – the approaches and the products
  • Get the right narrative and the right benefits to the right workplace at the right time
  • Share the HWL contribution and approach to cultural shift with Aberdeenshire Council and Aberdeenshire CPP to encourage collaboration.

Assessment

Engaging the Fish Processing Sector

Thirty two independent fish processors based in Peterhead and Fraserburgh were identified through the Food Standards Agency website and sent HWL information. Those with an available telephone number were followed up 3-4 weeks later (n=22). There was no engagement using this method.

Umbrella organisations associated with the fish processing sector were then identified. A collaborative approach to the promotion of HWL, through the Scottish Seafood Association,to all fish processor members was agreed. However, economic challenges and reprioritisation by the Association have made this approach no longer viable.

Subsequent meetings with Community Planning Partnership Groups in Aberdeenshire identified additional contacts, including Port & Harbour Authorities, who may facilitate engagement with the fishing and fish processing sectors.

AgriculturalSector

The wide demographic spread of workers within the agricultural sector suggested collaboration with the National Farmers’ Union Scotland (NFUS)as the optimal partnership to promote health and wellbeing to benefit their members. A ‘health fair’ was the preferred format to engage with as many individuals in one day and cover a number of health topics relevant to this sector.

The organisedhealth fair had to be postponed due to a prolonged period of unseasonably wet weather. Further talks with the NFUS resulted in the rescheduling and remodelling of the event.

The event in November 2015 was by invitationfrom the NFUS to members, and could accommodate 50 delegates. There were 25 positive responses with 21 delegates on the day.

Delegates fedback formally, though most provided limited information. Overall, health concerns related to lone working (mental health) and the physical nature of the work. The majority of respondents reported that they worked alone with only a small number who indicated they had one or two employees (often family members). None reported wages below the living wage. There were no requests for further HWL information or for a visit from an advisor. Overall the reported and anecdotal feedback from those attending the event was extremely positive -“well worth taking the time out to attend” and a greater awareness of the topics discussed. Interest in attending future health promotion events was expressed.

NFUS expressed a keen interest to pursue health promotion for their members and have suggested a future health event could be hosted in conjunction with a popular event such as a stock judging day. This would ensure a greater number of members receiving health, safety and wellbeing information.

NHSG HWL team also attended the Turiff Show, thelargest annual agricultural event to be held in Aberdeenshire.Thirty seven organisations expressed interest in further information and were followed up by email, resulting in two HWL registrations for, indicating an interest in this programme. Informal feedback from businesses approached confirmed a lack of interest in HWL ‘we don’t need that..... too small an organisation’, ‘can’t afford the time or money on health promotion in the current climate’.

In conclusion:

  • Little, if any appetite amongst SMEs for HWL award registration
  • Little , if any response to contact and information by post
  • Very limited response to subsequent follow up conversation by telephone
  • A measure of success, through the opportunity of face – to - face conversation, as part of a larger initiative e.g. an event hosted by the industry sector lead body
  • A measure of success where there is appetite and opportunity to work with sector members, under the auspices of the trade association or sector lead body e.g. the NFU.
  • A positive cost benefit analysis of input by NHSG for output, such as SME and or trade association engagement, is not promising at this point.

Recommendations

Partners are asked to:

  • Note the analyses which have informed current action
  • Note the investment of time and other resource to date by NHSG to support SMEs to enable their employees to live as well as they can
  • Note the specific risks to health and wellbeing in the two sectors involved (Annex A)
  • Note the minimal traction secured with the two sectors involved
  • Consider the important role of partners, and all employers to improve health and reduce inequalities
  • Note the important simple steps which employers can take to improve health and reduce inequalities (Annex B)
  • Consider any tangible support which partners can make, individually and collectively to work with NHSG to increase engagement with SMEs on simple steps to encourage and support employers to enable employees to keep well, and to minimise days lost through illness or accident.

References

*Health Scotland’s nationally agreed proxy for identifying organisations with staff at greater risk of preventable ill-health.

Scott Porter Research (2014)Good Work – Insight into SMEs attitudes and understanding.

Allerton, L and Leighton-Beck L (2015) Workplace profiling in Grampian.

Andrea Gilmartin and Dr Linda Leighton-Beck

Public Health, NHS Grampian, March, 2016.

Associated Health Risks Appendix A

Farmers

  • Manual handling and musculoskeletal disorders[1] – lifting and handling, both crop and animal production typically use repetitive motions in awkward positions and which can cause musculoskeletal injuries
  • Respiratory disease[2]: exposure to substances that cause breathing difficulties, asthma or other respiratory diseases (farmers lung – spores)
  • Zoonoses[3]: All farm animals carry a range of disease, some of which can be passed to humans.
  • Skin problems[4]: chemicals and hazardous substances such as pesticides & veterinary medicines (sheep dip)
  • Pesticide poisoning- due to spills and splashes, defective, missing or inadequate protective equipment, working in a field where pesticides have recently been applied; breathing in pesticide "drift" from adjoining or nearby fields; eating with pesticide-contaminated hands
  • Noise[7]: farming machinery.
  • Mental Health – Stress due to financial pressures resulting from market fluctuations, livestock disease or poor harvests, isolation
  • Farmers work past retirement age – increasing health & safety risks
  • Cancers – skin, lip, stomach, brain, and prostate, associated with pesticides, engine exhausts, solvents, dusts, animal viruses, fertilizers, fuels, and specific microbes may account for these elevated cancer rates

Fish Processors

  • Unprotected machinery - Hand trauma (cuts, lacerations, calluses)
  • Wet surfaces causing slips and falls - Sprains and fractures
  • Electrical cables on wet surfaces – Electrocution
  • Splashing of fish secretions (bile) - Corneal erosions
  • Noise (cannery) - Noise induced hearing loss
  • Low temperatures (freezers) and wet environments - Hypothermia, frost-bite, Raynaud’s, asthma aggravation
  • Irritants (hand cleaners, soaps, detergents) - Dermatitis, rhino-conjunctivitis, asthma
  • Toxic gasses in fish holding tanks (hydrogen sulphide) – Asphyxiation
  • Hypertonic saline aerosols (sea water) - Aggravation of asthma symptoms
  • Spiny fish - Hand trauma (puncture wounds, lacerations)
  • Fish proteins (muscle, blood, enzymes) – Rhino-conjunctivitis, asthma, urticaria, dermatitis
  • Mould in wet, damp, humid environments - Infection, rhino-conjunctivitis, asthma, urticaria, hypersensitivity pneumonitis
  • Repetitive work (cutting and trimming of fillets), forceful motions of upper limbs, constrained neck postures (sorting), prolonged standing (grading, sorting), loading bags and cans - Musculoskeletal cumulative trauma disorders (neck pain, shoulder girdle pain, elbow pain/epicondylitis, wrist pain/carpal tunnel syndrome, lower backache)
  • Excessive speed on work line, poor workplace organisation - Stress related symptoms (anxiety, insomnia, digestive problems), fatigue.

Simple steps organisations have used to address inequalities Appendix B

Inequalities / Examples
Lone workers /
  • one organisation asked this particular group of workers to look at their policy and procedures to see if fit for purpose as they were the employees directly affected
  • if any changes they would look at as specific group
  • then emailed around all other employees to let them know why this group of workers were looking particular at this policy
  • some issues around understanding that health topics that could affect lone workers

Shift Workers /
  • one organisation organised their lifestyle checks for all employees, however understanding that they had some employees who were night shift workers
  • put on a session earlier in the morning to accommodate this group to ensure they had the same access as all other employees

Lone Workers/Working from Home /
  • one organisation looked at the risk assessments required for employees working from home and what this entailed
  • managers were trained in the policies and procedures and risk assessments and then information sent to all employees as an update

Limited employee working either lone workers, peripatetic workers, shift workers /
  • this organisation although has very limited employees working either (lone, peripatetic workers /shift workers) explained that they have put a number of things in place to ensure nobody is excluded from HWL activities
  • An information cascade system ensures that information always reaches individuals, there are regular team meetings that include all employees, and The Hub and other IT provision has remote access for people that are off site for part of their working week
  • When HWL events are delivered, the Committee is aware of part time workers and those on shift patterns, and the timing of events is varied to accommodate these individuals

Carers in the workplace /
  • a number of organisations have recognised the number of employees they have those who also have caring responsibilities
  • Here a number of activities and events have been promoted, organisations have had local organisation to visit to talk about assistance and information is available within their area, attendance management policies been promoted
  • Carers within the office
  • We are applying for the Carers Positive Kite mark and feel that the input from this would help our staff
  • Several staff didn’t realise that this was available to them
  • Available help has now been made more accessible to staff which they appreciate

Groups within organisation /
  • One organisation have completed a health inequalities impact assessment on all their groups linked within the organisation

Lone Working (out of hours/work from home) /
  • The HWL group elected to concentrate on the Lone Working Policy as part of the criteria
  • Lone Working included those employees who may work “out of hours” and those who may “work from home”
  • There was a need to ensure that employees were aware of the Risk Assessment that should be completed as well as ensuring managers were up to date with policies and procedures and that these were implemented
  • Evidence provided included: Promotion policy, procedure guidelines and risk assessment paperwork in relation to lone working
  • The implemented changes include:
  • Procedures outlined to those who may be affected by lone working or working from home with risk assessment completed
  • Risk Assessment training for managers carried out to ensure that managers were aware of existing policies and procedures
  • The HWL group promote workshops for managers around health inequalities
  • Promotion for lone worker information disseminated through their E-Newsletter

Older workers/
disabled workers /
  • The organisation sought advice from the HWL advice line on what/who would be considered a health inequality in their workplace
  • The HWL Advisors offered local advice once discussions were explored to suit the needs of the organisation
  • They agreed to look at issues surrounding older workers and disabled workers
  • Although a lot of the work around disabled workers may be have legislative issues the organisation would have to consider looking at e.g. parking issues for disabled workers
  • Changing and ensuring that disabled workers gained the closest entry to the workplace
  • Medical checks – each employee has the opportunity to have a full screen medical every two years within the organisation
  • For older workers the organisation promoted that over the age of 40 years, these employees would have the opportunity to have a full screen medical on a yearly basis if they chose
  • The organisation has agreed that they could promote the reasoning and the meaning of health inequalities to all employees within the workplace

Lone Working /
  • The HWL group used the information gained from a safety meeting held in November/December 2013
  • Employees raised concerns with the Safety Department around lone working in certain areas on board
  • There are a small minority of employees that this affects, and employees highlighted some of the challenges they face when working in areas on board alone
  • At the meeting concerns were raised that other employees on board, did not even know there are lone workers
  • The HWL group identified that the Lone Working Policy should be highlighted and promoted for all employees and that this should be included in the induction process
  • Employees appeared to be well informed of the policy and procedures on lone working.
  • The HWL Group have already considered doing further work with them and are keen to investigate and develop an action plan.

Younger workers/ apprentices /
  • Younger workers and apprentices have been identified as potential vulnerable workers/health inequality areas.
  • Younger workers can face some challenges when beginning work on an oil rig:
  • Being away from home (perhaps for the first time)
  • Shift working
  • Living with others
  • Being at sea
  • At the moment there is a buddy system in place but there is an appreciation within the majority of the group that more needs to be put in place, at the moment, there is no clear guidelines

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