Changes to Department of Health immunisation schedules - pneumococcal vaccination for all welders
The Department of Health in the UK publishes recommendations about vaccination, both for UK infectious disease (the Green Book) and for overseas travel (the Yellow Book). The latest version of the Green Book makes a recommendation of routine vaccination against pneumococcus (a bacterial cause of pneumonia) for welders.

The updated version of the Green Book is available at http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_131000.pdf
The wording is :Individuals at occupational risk
There is a strong association between welding and the development of pneumococcal disease, particularly lobar pneumonia (Palmer et al., 2003;
Industrial Injuries Advisory Council, 2010). Therefore, welders who have not received the pneumococcal polysaccharide vaccine (PPV23) previously,
should be offered a single dose of 0.5ml of PPV23 vaccine. Employers should ensure that provision is in place for workers to receive PPV23.
The 2 quoted references (and a third relevant one) are available at : IIAC report 2010 http://iiac.independent.gov.uk/pdf/lobar-pneumonia-welders.pdf
Palmer KT, Poole J, Ayres JG, Mann J, Sherwood Burge P, Coggon D. Exposure to metal fume and infectious pneumonia, Am J Epidemiol 2003;157: 227-233. http://aje.oxfordjournals.org/content/157/3/227.full.pdf

Palmer, Keith T., Cullinan, Paul, Rice, Simon, Brown, Terry and Coggon, David (2009) Mortality from infectious pneumonia in metal workers: a comparison with deaths from asthma in occupations exposed to respiratory sensitizers. Thorax, 64, (11), 983-986
http://thorax.bmj.com/content/64/11/983. This is an important change in preventative medicine for all workers who can be exposed to metal fumes – principally welders. The vaccination is required just once in a lifetime, and is identical to the vaccine given to all over-65 year olds to reduce the risk of pneumonia. WellWork is experienced at running 'flu vaccination programmes and also vaccinations for overseas travel – we are able to organise mass vaccinations clinics, and follow-up sessions for those who are initially unable to attend. This is a topic that is of relevance to virtually every engineering company in the country. Please make contact with your local WellWork office to discuss your requirements.

HSE now publishes legislation twice per year – 1st April and 1st October.  Legislation is predominantly driven by European Union Directives, with UK legislation required within 3 years from the EU Directive.  UK legislation regularly exceeds the minimum standards, but there has recently been a challenge that the UK has inadequately implemented EU Directive 2003/18/EC in the Control of Asbestos at Work regulations 2006 (CAR) – specifically in terms of the types of asbestos allowed to be removed without a licence.  The UK proposed method to resolve this will create a new category of non-licensed Asbestos work – “Notifiable Non-Licensed Work” (NNLW).  Additionally workers carrying out work in this category will require health surveillance.  The consultation has suggested that this should be every 3 years (licensed workers continue to have health surveillance every 2 years), and conducted by the existing system of Appointed Doctors.

The new category of health surveillance will likely include maintenance staff and supervising staff in facilities management, as well as some specialist samplers (e.g. Occupational Hygienists).  Employers will need to revisit their procedures for this type of work, and identify staff who will need this health surveillance – some employers have been undertaking this type of “reassurance” examination for a number of years, and will simply need to formalise the health checks.

HSE estimates that the new provisions and health checks will apply to approximately 600-725,000 workers, but perhaps only 30% will be selected for health surveillance.  There will be a requirement to keep health records (statutory records of medical examinations) for a period of 40 years (the same as COSHH).

Currently HSE Medical Branch has a moratorium on making new “Appointed Doctors”, and it is difficult to see how such a large number of potentially in scope workers could be achieved with the current numbers of ADs.  We will need to await the finished Asbestos Regulations 2012 to understand exactly how this will work.  All of WellWork’s Occupational Physicians are Appointed under the Asbestos Regulations 2006, and so we are well placed to make an early start on health checks should employers wish to get ahead of the requirement.

The Consultation has now closed but can be viewed at http://consultations.hse.gov.uk/gf2.ti/f/15426/401829.1/pdf/-/CD237%20Complete.pdf

 

This month I am thinking about rehabiliation back to work.

Given that roughly 50% of long term absence is mental health, this is the most important, but also the most challenging group.
The Royal College of Phychiatrists has recently developed some pages specifically about the issues, with advice for employees, employers and heathcare professionals. Their advice mainly points to existing pieces of advice on the internet, but also has developed some new advice. It can be accessed at http://www.rcpsych.ac.uk/mentalhealthinfo/workandmentalhealth.aspx. GPs in England, Wales and Scotland have had the new format of "Fit Notes" for over 12 months, research on the impact is guarded http://research.dwp.gov.uk/asd/asd5/summ2011-2012/733summ.pdf.(summary) http://research.dwp.gov.uk/asd/asd5/rports2011-2012/rrep733.pdf (full report) - 38% of GPs have not substantially changed their practice of issuing Doctor's statements for work. DWP in response have recently funded educational material for GPs, and others in a well structured site (Healthy Working England). There are a number of case examples which are useful to complete http://www.healthyworkinguk.co.uk

One of the bug-bears in rehabiliation back to work is the expected length of absence after surgery, where patient expectations, and GP certification, has not kept pace with changes in surgical techniques. This is most apparent for hernia surgery and hysterectomy, as described in Dr Tony Williams' listing: http://www.workingfit.com/Surgery/FitnessSurgery.html. The Royal College of Surgeons of London and the Royal College of Obsterics Gynaecologists produce detailed patient guidlines, including likely timescales for absence/return to work.

Again in England, the National Institute for Clinical Excellence (NICE) is starting to see Return to Work as an indicator of success for any particular treatment pathway. In the formulaic approach to modern medicine, this is a welcome arrival. http://www.nice.org.uk/nicemedia/live/11779/43545/43545.pdf. The experience of the Leicester Fit4Work pilot has some good examples http://www.nice.org.uk/usingguidance/sharedlearningimplementingniceguidance/examplesofimplementation/eximpresults.jsp?o=451

As a final thought on a similar issue of health behaviours, a particularly difficult group of employees to address are Migrants. The HPA has recently developed a microsite which highlights country of origin specific risks and the rights of access to NHS treatment for these employees. http://www.hpa.org.uk/migranthealthguide. Our Occupational Health practitioners make regular use of this type of advice, contributing to reductions in long-term absence of employees. If you want to know more, please contact your local WellWork clinic.

A change in author this month to Geoff Helliwell, Steve Deacon will be working part-time at WellWork, and I have resumed the role of Medical Director.

Strange to be talking about Influenza in June, but now is when you should be considering your response to this business interuption risk. Department of Health have updated their advice about Influenza for the 2011/2012 season - http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalassets/dh_127082.pdf

This shows that vaccine uptake was slightly less in 2009/10 than 2008/9, but still over 50% for the risk groups under the age of 65 (just below 50% for Wales) Uptake by front-line Health Care Workers rose from 24 to 34% - the NHS is hoping to improve on this.

The key feature of the change in antigen to Swine Flu (H1N1), is that the disease is preferentially affecting younger persons, and especially children/pregnant women. The programme for NHS vaccinations now invludes children aged 6 months to 13 years old in the at risk group, and all pregnant women. Health and Social Care employees remain in the groups for vaccination, to be arranged by their employers. There will therfore likely be an increase in general use of vaccine this year, but with also a planned increase in production. Influenza vaccine should not be in such short supply as in the last 2 seasons. Even so, if you are considering vaccination programme for your employees, you should be placing an order now.

Influenza vaccine is most effective in seasons with a new type of antigen, such as the last 2 years, and can be assumed 2011/12. Employers with younger workforces, or who deliver vital services to customers, should be considering vaccination to minimise the business interruption risk.

For more information please contact your local WellWork clinic.

The fit-note was introduced in April 2010. A recent review has evaluated the use and impact of the Fit Note by GP's in managing sickness from work. The key findings are:

 

- 90% agreed that work is beneficial to health

- 88% agreed that staying in or returning to work is an important GP role

- 70% agreed the Fit Note helped their patients make a phased return to work

- 61% agreed the Fit Note has improved patient discussions about returning to work

- 48% agreed the Fit Note facilitated earlier return to work to aid recovery

 

Overall it appears that the Fit Note has started to have a positive impact. However it does not replace Occupational health advice. GP's are the advocate of their patients and may sometimes complete Fit Notes recommending work adjustments that may not be available or reasonable. It is for the employer to decide work placement arrangements. Employers may seek occupational health advice for assistance in difficult absence cases. Where there is a difference between the GP and Occupational Health advice, the employer is entitled in law to place more reliance on occupational health advice as this is 'specialist' advice.

 

For assistance with managing sickness absence and especially in resolving complex medical cases please contact your nearest WellWork centre.

The first conviction under the Corporate Manslaughter and Corporate Homicide Act 2007 was made in February 2011. Cotswold Geptech was found guilty of causing death of a junior engineer who was killed by the collapse of an unsupported excavation. The court decided that the company had been grossly negligent in failing to protect their employee who was at foreseeably risk of injury. Geotech was fined an unprecedented £385,000 equivalent to 250% of their turnover. This judgement has sent a clear message that corporate manslaughter is a very serious offence and that directors must understand their health and safety obligations and ensure that safety obligations and ensure that safety management systems are robust.

Seasonal flu is a significant health concern for vulnerable employees during the winter months and also
for employers wishing to constrain their sickness absence. Each autumn General Practitioners routinely contact their patients who are considered at increased risk of flu infection. These include those suffering with chronic illness such as diabetes, reduced immunity, existing chest disease and those aged over 60 years. Flu immunisation is also recommended for those caring for vulnerable clients to protect them from possible infection.

However, many otherwise well persons seek flu immunisation as a general health protection measure. Many employers encourage immunisation and some provide workplace flu immunisation as part of their wellbeing strategy and as a measure to constrain sickness absence in the winter months.

This winter there has been continuing concern about swine flu in addition to seasonal flu. The current flu vaccine is a mix of these two types. There has been a big uptake of flu immunisation and some GPs are reported to have run out of supplies. However, the latest figures from the Health Protection Agency indicate that levels of seasonal flu may be starting to peak in England, Wales and Scotland and we may be over the worst. This is to be interpreted with caution as the rate of consultations will have decreased owing to school and GP surgeries closing over the holiday period.

Those employers concerned to protect their employees through workplace provision of flu immunisation should contact their regional WellWork centre for advice and information on possible arrangements and costs. Flu vaccine supplies needed to be ordered in advance and workplace programmes for next winter should be anticipated well beforehand.