It is up to all professionals to be clear and assured about their com- petencies, and aware of the limitations of their knowledge. As well as knowing where to obtain information, it is also crucial to know what, and to whom, to refer when you do not have the relevant competency.
Engendering a Safety Culture: Health and Safety
The role of the occupational health expert is to assist the employer in meeting legal obligations under Section 2 of the Health and Safety at Work etc. Act (1974). This involves:
r Keeping the employer aware of their role and responsibilities regarding provision of appropriate standards of pre-employment screening, necessary periodic health surveillance and sickness-absence control.
r Keeping the employer informed of the implications of new legislation and its relevance to health surveillance programmes.
Figure 8.3 The Role of the Occupational Health Expert on the Health and Safety Committee
Where there is a unionised workforce, there is a requirement to es- tablish a health and safety committee when two people have asked for one.This requirement does not apply to non-unionised workforces, but the Health and Safety Commission recommends the establishment of committees in all except smaller establishments. Since 1996, regulations have required all employers to consult employees on health and safety matters (HSE 1996).
Teamwork
Occupational health and safety problems often need input from a variety of people, such as physicians, hygienists, safety experts and nurses, as well as employers, employees and safety representatives. Finding solutions ideally involves a team approach to problem solving, which often involves the following stages:
r Assessing the risk.
r Deciding what needs to be done to reduce the risk.
r Deciding who are the best people to do the job, depending upon the particular circumstances, legislative requirements and their expertise.
The general approach to a consideration of safety matters requires an understanding of the people, policies and structure of an organisation.
A useful start to considering relevant factors about an organisation’s safety culture is to ask questions such as those listed in Figure 8.4.
If there are safety personnel (either in-house or external consultants) then good communication with them is crucial for a team approach.
The occupational health nurse’s training and background knowledge of physiology should be complementary to the safety officer’s training and expertise. In some smaller companies the occupational health nurse may have been appointed in the joint role of occupational health and safety adviser; this will require additional training in safety matters (Davies 1999).
r What are the hazards?
r How many employees are there and what is the breakdown in terms of age, sex, jobs, skills?
r What are the legislative requirements?
r Is there a health and safety policy statement (required if there are five or more employees) and supporting policies? Are they satisfactory and regularly updated?
r Is there commitment to health and safety from top management?
r Are management and staff aware of their responsibilities regarding health and safety?
r Is there a health and safety committee?
r What is the accident reporting and follow-up system?
r Have risk assessments been undertaken and documented?
r Does audit occur and are staff involved?
r What systems have been established, and how well are they are they working?
r Is there induction training and a rolling programme of training on health and safety, and how effective is it?
r Is there a safety department or adviser?
r Are there departmental representatives?
r Is there an occupational health nurse?
r What are the skills and responsibilities of the occupational health nurse?
Figure 8.4 Some Questions to Ask when Assessing the Safety Culture of an Organisation
In some local authorities there are large health and safety depart- ments, with several health and safety officers working as a team and specialising in different areas such as manual handling, fire safety and health promotion. Some large companies have a separate occupational health department staffed by physicians and nurses. Most occupational health nurses have a safety adviser colleague but usually only part- time medical advice. Only a few large companies and hospitals have a team of physicians, nurses and health and safety specialists pro- viding a fully comprehensive occupational health and safety service.
As previously discussed, whoever is providing health and safety ad- vice must be ‘competent’ under the legislation.
The following case study demonstrates how an occupational health nurse can make a difference to workplace health and safety by working in a flexible and imaginative way as a team member.
Manual Handling Case Study
The charity Backcare estimates that the cost of back pain to the NHS, the economy and society is £ 5 billion per year (HSE 2006c). In the health care sector back pain is one of the main occupational risks. Loss of nurs- ing staff through sickness absence and retirement due to back injury is a drain on resources, in addition to the human cost to those injured in terms of pain and suffering, loss of income and possible change of career. Nurses have been awarded damages for back injuries sustained
at work (£ 803 000 in the case of Douglas v Bexley and Greenwich Health Authority 2000). So how should a hospital try to reduce the risk to staff from back pain and comply with the Manual Handling Regulations, while providing the best possible care for patients? How can occupa- tional health nurses help?
The 1992 Manual Handling Operations Regulations state that man- ual handling must be avoided so far as is reasonably practicable. If this is not possible then an assessment must be made of the operation in- volved. There is a requirement to reduce the risk of injury. Assessment is to involve employer and employee, and includes looking at the task, load, environment and individual capability. Records must be kept, and training given. The regulations state that following assessments ‘it is not sufficient to make changes and then hope that the problem has been dealt with. . .monitoring must continue.’
This hospital approached the issue by establishing a manual handling working party, which included representatives from all involved parties (including the occupational health nurse manager). It considered best practice and studied the requirements of all relevant law (including the Manual Handling Operations Regulations), as well as the latest good practice guidance, such as HSE and Royal College of Nursing publica- tions. The working party then produced a policy covering all aspects of the hospital’s strategy for meeting the regulations. The policy was clear, concise and well-communicated, and systems were put in place for updating and periodic audit of the policy.
It is crucial that hospitals receive competent advice, and the work- ing party reviewed how other hospitals had dealt with this. It found that several hospitals were using their own physiotherapists, working with occupational health nurses, trainers and ward nurse facilitators whom they had trained. Other large hospitals had appointed full-time manual handling trainers with physiotherapy or nursing backgrounds.
One local hospital had decided to use an independent manual handling trainer who was an occupational health nurse by training. By match- ing this independent trainer’s course to its local needs and taking up references, this employer demonstrated that it had taken precautions in establishing the trainer’s competence and was pleased with the re- sults. It was able to demonstrate that it had studied what was required and felt confident that it had appointed competent, trained and expe- rienced members of its own staff to work with the independent trainer in implementing the most suitable policy for the hospital. The working group decided to appoint the same independent trainer to help it set up its training for managers and staff involved in manual handling and to advise on assessments.
There are thus several acceptable ways of achieving the same end of complying with the requirements of the Manual Handling Regu- lations for individual organisations. The onus is on the employer to
demonstrate that they have done what could reasonably be expected in establishing the suitability of whoever is nominated as the competent person.
Conclusion
Occupational health and safety are everyone’s responsibility and are inextricably linked. Clearly, the requirements and opportunities for the occupational health nurse to work in health and safety vary greatly de- pending on the setting. Whatever the situation, however, occupational health nurses need an understanding of the health and safety legislation relating to the workplace they are advising. It is up to all professionals, including occupational health nurses, to be clear and assured about their competencies, to keep up to date and to be aware of the limitations of their knowledge. As well as knowing where to obtain information, it is also crucial that they know to whom they can refer when they do not have the relevant competency.
This chapter has provided an historical overview of health and safety in the UK, with particular reference to the links between occupational health and health and safety. Two key themes that run through health and safety legislation and guidance, namely risk assessment and the competent person, were outlined. The aim was to illustrate some of the ways in which the occupational health nurse can make a difference to workplace health by keeping abreast of health and safety issues and getting actively involved in collaborative working with employers, em- ployees and health and safety colleagues.