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Features
The long road back

Monday, March 26, 2001

Everyone agrees that the rehabilitation of employers who have suffered injury or ill health in the workplace makes sense on moral, humanitarian and economic grounds. But how do we make the quantum leap from theory to reality. Hélène Ashe-Roy reports from a TUC seminar on Getting People Back to Work and the thorny issues involved

In the UK around 25,000 people each year leave the workforce permanently because of work-related injury or ill health. This represents a massive loss all round – to the victims who suffer pain, poverty and loss of self confidence, to the employer who loses workers and their skills and to the tax payer who pays twice, once in lost tax revenue and again in higher state expenditure.
In June and July of last year, the government and the Health and Safety Commission launched two, new 10-year plans, Revitalising Health and Safety and Securing Health Together, in which the issue of rehabilitation moved sharply up the agenda. Currently under discussion is whether to make it a legal requirement to add a rehabilitation policy to employers’ current health and safety policy.
If ill health retirement is a lose/lose situation all round, then it should go without saying that effective rehabilitation must offer a win/win one. But when one considers the number of parties involved in changing the present mindset, it is understandable why the subject of rehabilitation is a thorny one.
From the government we have the Departments of Social Security, Education and Employment, Health, the DETR, the HSC and the Treasury involved. From the employee’s side we have the trade unions and other employee legal and medical representatives and sufferers’ organisations, from the employer’s side the insurance industry and their legal and medical representatives, and finally healthcare providers, both the NHS and private companies. If ever there was an issue that needed joined-up thinking, this is it.
In an effort to raise awareness of the many issues involved, the TUC has been running a series of seminars up and down the country throughout last year, featuring speakers from all the interested parties.
“We need a new deal for injury victims just like the New Deal for the unemployed,” says Maureen Rooney, a national officer of the TUC General Council and member of the Health and Safety Commission, setting the scene at one of the seminars.
“We need prompt medical treatment, such as physiotherapy, chiropractic or osteopathy, adaptations to the workplace so that employees don’t suffer the same injury again and retraining. And someone, such as a case manager, needs to have responsibility for each case.
“The NHS acts perversely by providing treatment free, thus relieving employers of the need to act and from financial and moral responsibility. The Employers Liability Insurance does much the same thing in that it provides a safety net which protects employers and employees from the financial effects. Rehabilitation is always seen as someone else’s problem.
“But it is a dangerously unsustainable problem. Employers are only evading a fraction of the cost. Rehabilitation costs far less than lost production and sick pay which cannot be recovered from insurance. The responsibility for rehabilitation needs to lie with the employer.”
At present, barely a quarter of employers provide access to rehabilitation services. But where they do, it has been found that sickness absence rates have fallen so sharply that the service has paid for itself within a matter of months.
But rehabilitation will only work on willing participants and that includes the employee’s managers, says Dr Richard Welch, director of employee health services and chief medical adviser at the Post office. There also has to be competent case management and an effective way to measure outcomes.
When the Post Office carried out its Q health survey among its 200,000 employees, the largest health survey in Europe, out of the 60,000 replies five per cent reported a disability that impacted on their work. And, from the experience of the Post Office’s Disability Advice Centre, it’s not simply a matter of providing physiotherapists and osteopaths, a third of those who contact the centre have psychological or mental health problems.
“It’s infernally difficult to quantify costs and benefits,” says Dr Welch. “What’s the base? Do we have the figures on absence and sickness rates? And it’s very difficult to monitor performance and difficult to measure. But our medical retirement used to run at about 0.8% a year, around 1870 people. It’s now less than 1400.”
From the point of view of the insurer the case for rehabilitation is overwhelming. Workplace injury claims amount to about £900m a year and 2m working days are lost a year costing employers several billion pounds.
But a major impediment stands in the way of introducing effective rehabilitation programmes, and that is the UK’s tort culture, the need to establish blame, which prevents rehabilitation being started at the earliest possible moment and therefore making it less effective.
This adversarial culture means that there is little trust between the different parties involved. Claimants and their lawyers are not easily going to believe that employers and insurers are putting the welfare of the claimant first. It is hoped that the recent Woolf reforms will go some way towards creating a change in attitude.
“Speed is of the essence,” says David Grimley, technical claims manager at St Paul International Insurance Company. “If rehabilitation is started within three weeks of the onset of the problem, the chances of the person returning to work are 20% greater than if treatment starts more than 20 days after the onset of the problem.
“Insurers have always had the fear that doing anything for the employee was going to be an admission of liability. Starting a rehabilitation programme should not mean an admission of liability. Rehabilitation should be provided as an automatic benefit for employees and then liability would not be an issue.”
There has been a tendency to point the finger at lawyers as being the spanner in the works when it comes to rehabilitation, as cases are dragged out for years in the hopes either of winning enormous sums in compensation or using rehabilitation as a litigation weapon to lower the employee’s claim.
In all of this little consideration is given to what is best for the victim. According to Simon Dewsbury, solicitor with Thompson’s, the UK’s largest national personal injury firm, the first thing an accident victim wants is an explanation and an apology. Next they want their employer to learn from the accident so that it doesn’t happen again.
Third on the list is compensation for the injury and fourth, and more importantly than any of the others, they want to get their lives back to normal, or as normal as possible.
“As a claimant lawyer I have no hesitation whatsoever in saying that I am much happier settling a case for £100,000 where the claimant is able to return to some sort of work and have his disability needs met to improve the quality of his life than having someone get £200,000 to £300,000 or even more but be out of work and have a poor quality of life,” says Mr Dewsbury.
There are signs that the effects of the Civil Justice Reforms are having an impact on the speed with which cases are settled, with 85% of cases falling within the Fast Track and capable of being resolved within 12 to 15 months.
Rehabilitation is the last great unfulfilled promise of the welfare state,” concludes John Monks, secretary general of the TUC. “Recently we’ve seen a major shift in the rehabilitation debate from non-issue to non-contentious. Now it’s a matter of when, not if, we do the right thing for the victims.”
But with our fragmented use of skills and resources, continuing lack of trust between claimants’ solicitors and insurers and complex involvement of at least five separate government department, there is still a long way to go.
“It’s not going to be quick and easy,” says Maureen Rooney. “It will require considerable effort from government, unions, insurers, lawyers and sufferers organisations. Who is going to pay for it? How far should it be voluntary? Do we trade money for health? How do learn to trust employers, insurers, medical experts? And should rehabilitation be built into management policies?”

Features
On the road again

Wednesday, May 09, 2001

On March 1, the HSC launched a discussion document on work-related road accidents. RoSPA has long campaigned for road risk to be managed and regulated in the same way as any other occupational health and safety risk. Roger Bibbings, RoSPA’s senior safety adviser, outlines the key themes on which discussions should focus

There is going to have to be a clear and practical focus on the responsibilities of managers of workers who are required to drive or work on the road as part of their job. Positive examples of senior management leadership by words and deeds, including senior managers' own driving behaviour will need to be given
Over the next three months the government's Work Related Road Safety Task Group (WRRSTG) will be initiating a national debate around the proposition that employers should be managing risks faced (and created) by their employees on the road as part of health and safety at work.
The underlying idea is that organisations should be taking action to promote the safety of their staff while at work on the road, whether as drivers, passengers or pedestrians. The group, which is chaired by Richard Dykes, a senior director in the Post Office, is convinced that occupational road risk is a major but still generally neglected issue.
In part this is because the Health and Safety at Work Act has not been enforced in this area. However, it is clear that there is a very strong business case for action in this area. Not only can managing occupational road risk (MORR) improve overall employee safety but it can help reduce the resulting costs of accidents and create efficiency savings, improve an organisation's safety image and make a significant contribution to meeting road safety targets.
ROSPA, which is represented on WRRSTG, has been campaigning for the last six years for organisations to adopt a proactive risk management approach to reducing the risks connected with 'at work' vehicle use.
Driving for work is clearly a risky business. For example, car and van drivers who cover 25,000 miles a year as part of their job are at virtually the same risk of being killed at work as construction workers; and company car drivers have nearly twice the accident liability of drivers in general.
ROSPA has estimated that, out of a total of 3,400 road accident fatalities every year, between 800 and 1000 (25-30%) are likely to be occurring in accidents involving vehicles being driven for work purposes. Further evidence comes from the HSE’s survey of self reported work related injury which has shown that there are some 77,000 injuries to employees every year as a result of 'at work' road accidents.
Employers clearly have moral as well as legal duties to assess the 'at work' road risks and take 'reasonably practicable measures' to ensure 'safe systems of work' for their drivers. Many practical and cost effective control measures can be put in place, for example:

 reducing risks at source, for example by exploring safer alternatives to travel by road;

 specification of safest routes;

 setting standards for safe schedules, journey times and distance limits;

 selection of vehicles with additional safety features;

 ensuring safe maintenance;

 ensuring drivers are fit and having suitable driver selection, assessment and driver development arrangements in place to help them to cope with the risks on the road.
What ROSPA has been arguing however is that 'at work' road safety is not just a question of introducing specific control measures. The primary focus must be on ensuring that organisations have a systematic risk management capability, adapting the 'systems approach' to health and safety management advocated by the HSE.
In other words, unless organisations have:

 established and communicated clear road safety policies and objectives;

 have specified the responsibilities and competences required to achieve them at every level;

 have a planned approach to risk control informed by risk assessment and targets;

 can monitor their road safety performance actively and reactively and feed back lessons from periodic review; they will not be able to achieve a cycle of continuous improvement.
ROSPA is planning to make an input to the WRRSTG debate and will be making a presentation at a conference to be organised at the Barbican on April 5 as part of the discussion process. Over the next three months there will be a need to focus on key themes.
The scale of risk, harm and loss associated with 'at work' road accidents will need to be clearly set out at both the macro and micro levels so that policy makers and enforcers can re-assess where they stand and employers can be challenged to review their own at-work road safety performance in business terms.
There will need to be discussion of how to motivate employers to address MORR, including how to communicate the 'business case' (including ethical and reputational considerations) and how to enforce relevant law. Similarly there will be a need to focus on safety culture both as a determinant of manager and driver behaviour and in terms of using MORR programmes as a 'health and safety culture builder'.
There is going to have to be a clear and practical focus on the responsibilities of managers of workers who are required to drive or work on the road as part of their job. Positive examples of senior management leadership by words and deeds, including senior managers' own driving behaviour will need to be given.
There will be a need to avoid prescription and overall the tone will need to be 'goal setting/assessment' based. Blanket approaches are not likely to be effective. Employers cannot prevent all accidents but they can take reasonable steps to make them less likely and/or to reduce their consequences.
Thus, the focus will need to be on assessing where 'at work' road safety problems are likely to be most frequent/serious and tracking key indicators so that employers and employee representatives can develop and apply cost effective solutions. The impression should be avoided, for example, that every at-work driver should get driver training, regardless of risk exposure or development need.
Similarly, effective monitoring and data management are fundamental to MORR (no monitoring, no management) but the essence of what is involved will need to be explained carefully, for example when looking at what is appropriate for small firms.
What WRRSTG hope is that the discussion phase will actually throw up a lot of practical information, for example on the full range of control measures available. There will be a need to probe views and data on questions such as inappropriate use of speed and the contribution of fatigue to accident 'at work' road accident causation. There will be a need to look at the impact on driving of health , such as stress and musculo-skeletal.
Also near the top of the agenda will be a debate about how to establish more effective enforcement liaison arrangements between the police, the vehicle inspectorate and health and safety enforcers such as the HSE and local authorities.
ROSPA would like to see the HSE extending its inspection of employers' site transport arrangements to look at their systems and standards for controlling risk on the road. Where employers fail to create a safe system of driving (excessive hours, incentives to speed, required use of mobile phones on the move etc) they should be investigated and prosecuted.
More fundamentally there is going to be a need to establish a broad strategy for making MORR happen. The WRRSTG discussion document will explore implementation of the approach advocated via guidance, promotional and enforcement activity by state agencies. A broader vision is needed however of partnership between a wide range of key players committed to securing best practice as opposed to mere legal compliance.
That said, the HSC will also need to shift its focus, given their commitment to setting strategic priorities according to levels of risk and overall detriment. For example, when ROSPA at the HSC open meeting on January 15 asked a question about work related road safety the response was tentative.
HSE deputy director general David Eves stressed that it would be feeling its way carefully on this issue, reflecting perhaps overstretched HSE inspectors' anxieties about venturing into new risk territory, even though it seems fairly clear that more people are killed and seriously injured in 'at work' road accidents than in all other RIDDOR notifiable events put together.

The discussion document can be found on the HSE’s web site:

Features
Coughs and sneezes spread diseases

Monday, November 20, 2000

It might not hit the headlines, but the majority of short-term absences from work are caused by the common cold and flu viruses. As the clocks are about to go back and winter approaches, Hélène Ashe-Roy looks at some of the health and safety issues peculiar to the chillier months of the year.