Managing Health at Work Partnership Information Network (PIN) Guideline

MANAGING HEALTH AT WORK

INTRODUCTION

"Managing Health at Work" is a short title for a very large topic. NHSScotland is committed to protecting and promoting the health, safety and wellbeing of its staff*. The aim of this guideline is to help deliver that commitment.

Given the breadth of the subject, this Guideline makes no claim to cover everything in detail. However, its opening chapters (2 - 4) set out the general principles which apply across NHSScotland. Following these sections, the Guideline includes a range of topic-specific guidelines in a standard format. They can either form part of an overall approach or be taken out and used, where appropriate, as stand-alone guidelines. Where users need a guideline on a topic not included, it will be relatively straightforward to develop one using the general principles (Chapters 2 - 4) and the standard format.

As a PIN Guideline, it is one of a range of guidelines produced to help managers, staff and their representatives. There is inevitable overlap with, and cross-reference to, other PIN Guidelines. For example, the Guideline on Family Friendly Policies is relevant to health and wellbeing, and the Dignity at Work Guideline provides an approach to deal with issues of bullying and harassment. There is also both general and specific guidance, for example, around Radiation Protection or Visual Display Units, which applies to the NHS as to other bodies. The Guideline does not attempt to repeat that material: instead users should follow through cross-references etc as necessary.

The many individuals who contributed to the development of this Guideline will be using it in their own work. They believe it will be of key importance across NHSScotland.

*This Guideline uses the word "staff" to include direct employees of NHSScotland, those working in and for the contractor professions, volunteers and those working for voluntary and statutory agencies in partnership with NHSScotland.

1. PROMOTING EMPLOYEE HEALTH AND WELLBEING

1.1 Introduction

A healthy organisation is one that successfully balances the needs of individuals with the needs of the organisation as a whole. Within NHSScotland, it is well recognised that staff face a demanding working environment and are continually facing new challenges. Both of these factors have an effect on the physical and mental wellbeing of staff. NHSScotland depends upon a healthy, motivated workforce to deliver the service which the country needs and expects.

The importance of a healthy workplace is based upon the principle of co-operating and linking all the relevant initiatives, policies and opportunities together. Health at work is not only about health and safety, occupational health and promoting healthier lifestyles: the way in which work is organised also plays a major role.

There are four major components underpinning a healthy organisation:

• health and safety;

• promoting access to competent occupational health services;

• promoting staff health and wellbeing; and

• organisation of work.

The importance of co-operating and linking all the relevant initiatives, policies and opportunities cannot be over-emphasised. The Staff Governance Standard aims to make sure that organisations are committed to providing an improved and safe working environment for staff, and an annual self-assessment will monitor the organisation's delivery of this commitment. PIN guidelines such as Dignity at Work, Dealing with Employee Concerns and Family Friendly Policies also have a major contribution to make to health at work. The Partnership Forum is the mechanism by which health at work can be co-ordinated and duplication avoided. It must be stressed that the Forum's role is to co-ordinate and support the organisation in its efforts to manage health at work, without replicating the efforts or assuming the responsibilities of others in the organisation.

1.2 Promoting access to competent Occupational Health Services

It is crucially important that staff have access to competent occupational health services. Ill health can be caused by work, however ill health which manifests itself in the workplace can be caused by a problem in a staff member's home life. The Scottish Occupational Health Strategy - 'Towards a Safer, Healthier Scotland' recognises that the key to success of the strategy is based upon partnership, involving all of those with an interest in treatment, rehabilitation and prevention of disease. This strategy and the ten-year occupational health strategy for the United Kingdom 'Securing Health Together' outline the action necessary to achieve the competent occupational health provision for health at work.

1.3 Organisation of work

The way in which work is organised can have a major impact on the health of staff. It is clear from a number of surveys that staff feel better and perform better in a workplace where:

• there is an open and flexible culture with good communication;

• there is a genuine commitment to reducing stress;

• merit is recognised and achievement rewarded; and

• staff are properly trained and equipped to do their job with a realistic workload.

Stress has been reported as a major health factor in staff surveys across Scotland and Guideline 1 outlines the ways in which an organisation can take action to tackle stress and improve health.

1.4 Developing policy and structures

There is a number of health and safety related policies which by law have to be developed and implemented. These, however, should not be seen as the limit to an organisation's development of policies. A number of issues can benefit from having a stated organisational policy on how each issued will be addressed. The benefit of a written policy is that it provides a legitimate basis for action. Very importantly, it provides a clear point of reference. Such policies send clear signals to staff, patients, visitors and the outside world about the behaviour that is expected within the workplace, and about its ethos and 'health culture'. Policies are not just about the "do's and don'ts". They also support staff who want to make positive health changes (for example, to eat healthier food or give up smoking). Policies must be developed in partnership, and to be effective must apply to, and be seen to apply to, all levels within the organisation.

1.5 Nutrition

Diet and eating patterns are very clearly linked to health. In Scotland too many people have a nutritionally poor diet.

The consequences of a poor diet are obvious in oral as well as general health, with large numbers of people developing coronary heart disease, and certain cancers being typical. Obesity and eating disorders are also increasing.

Action to consider

For many staff working within NHSScotland, the circumstances of their work (for example, shift work, and/or long and unpredictable hours) mean that eating a well-balanced diet, and having regular meals, is not always possible. Nevertheless, a number of measures can be taken to help them:

• Actively promote the workplace nutrition policy to make sure that dining rooms and other areas provide a wide choice of foods and that the choice of ingredients, preparation and cooking methods are based on sound nutritional guidelines.

• Make sure that vending machines and snack bars sell healthier alternatives to traditional chocolate, sweets etc, such as fruit juices, wholemeal bread and sandwiches, fresh fruit, and cereal bars.

• If there is no dining room in the workplace, provide and maintain an eating area with access to a fridge so staff can store healthy foods brought in from outside.

• Encourage special events such as healthy-eating weeks or 'taste and try' days, to introduce new healthier food options in canteens.

• Help staff returning to work after maternity leave to get the next generation off to a good start by helping them to continue to breastfeed their babies.

• Provide food at times and in ways that suit shift workers or staff working irregular hours.

• All caterers in NHSScotland should aim to achieve the commended standard of the Scottish Healthy Choices Award. The co-ordinator can be contacted at the Scottish Consumer Council (0141 226 5261).

• Monitor, review and evaluate the nutrition policy.

1.6 Physical activity

Lack of exercise has a negative effect on health, and contributes to illness. Taking regular exercise helps to reduce the risk of heart disease and helps prevent obesity. A physically fit person is generally healthier and better able to cope with the demands of a stressful job. However, busy staff with little free time during the day may find it difficult to make time to exercise.

A physical activity policy demonstrates a commitment to provide both information and, if possible, facilities and other measures to encourage staff to exercise and to keep fit. It also encourages greater links between NHSScotland workplaces and other health-promoting settings in the local community.

Action to consider

• Encourage staff to walk whenever possible, for example, support the stair-walking campaign.

• Discuss public transport access with the local authority (and if possible improve it) and encourage the development and use of cycle paths.

• Provide exercise areas and fitness equipment.

• Provide lockers, changing and shower facilities for those taking exercise.

• Provide bicycle racks to encourage people to cycle to work.

• Provide information about local sports and leisure centres, classes and clubs.

• Provide subsidies for staff membership or entrance fees to local health or sports clubs, swimming pools or fitness centres. Discounted rates can often be negotiated with local authorities.

• Publicise sporting or other fitness events such as fun runs or walks, and support workplace sports and activity clubs such as aerobics, football, badminton, squash, etc.

• Offer health and fitness assessments to staff.

APPENDIX 1.1

References

Health and Safety Commission Securing Health Together, A long-term occupational health strategy for England, Scotland and Wales, HSE Books, London, 2000

National Audit Office Health and Safety in NHS Acute Trusts in England - A Report by the Comptroller and Auditor General, HC 82, 1996/97, 22 November 1996, ISBN: 0102626979

2. HEALTH AND SAFETY FRAMEWORK

2.1 Introduction

Organisations that successfully manage health and safety recognise that the relationship between controlling risks and general health is at the very centre of the business itself. Their approach rests on the principles in the Health and Safety Executive's guidance document 'Successful Health and Safety Management' HS(G) 65. The document clearly states that managing health and safety successfully is founded on effective systems which:

• set and develop policy;

• organise for health and safety;

• plan and put in place systems;

• monitor performance; and

• review.

NHSScotland has demonstrated through the staff governance agenda its commitment to be both a model employer and provider of occupational health and safety. The documents 'Securing Health Together' and 'Towards a Safer, Healthier Workplace' clearly set out the strategy in relation to this. It is essential therefore for each NHSScotland employer, in partnership with staff, to develop a health and safety management framework which will not only comply with legislation but will lead to NHSScotland becoming an exemplar employer. The main elements of such a framework are set out in Box 1.

Box 1 Structure for an occupational health and safety framework

1 Statement of commitment. 2 What the policy will cover. 3 Responsibilities. 4 Consultation arrangements. 5 Arrangements (systems and procedures). This section should link to, or include, the systems and procedures that are in place to reduce risk and provide a safe and healthy working environment. This will include ways of carrying out assessment to feed through to the planning process and then putting the plans in place. 6 Instruction and training, in particular: management training; risk-assessment training; induction training; and specialist training. 7 Sources of information. 8 Monitoring, including: inspections; reporting incidents; complaints; and claims. 9 Reviews audit.

2.2 Responsibilities of managers and staff

2.2.1 Senior managers are responsible for:

• making sure that there is a written policy which is regularly updated;

• assessing health and safety risks to staff and others - to identify measures needed under health and safety law;

• making arrangements for putting these measures into practice - including planning, organisation, control, monitoring and review;

• in conjunction with the Occupational Health Service, identifying and providing appropriate health surveillance;

• identifying and appointing competent people who are trained to carry out specific health and safety tasks;

• establishing the systems for communicating procedures to deal with serious and imminent danger;

• giving staff understandable information;

• giving staff adequate and appropriate training and instruction on health and safety issues;

• co-operating with other employers where premises are shared;

• consulting with safety representatives; and

• contributing to and developing appropriate organisational policies and standards.

2.2.2 Departmental and ward managers are responsible for making sure that:

• there is an up-to-date and clear written local policy which sets out the organisation's structure (the people responsible) and arrangements (the procedures to be followed) for identifying hazards, assessing risks and preventing or controlling them;

• staff know about the policy and making sure they understand it;

• the policy is compatible with the overall organisational policy;

• the policy is up-to-date and has a review procedure built in; and

• the policy identifies the need to scrutinise and review performance and that the policy is effective.

These managers must also check that personnel for whom they have responsibility are organised, so it is important to make sure that:

• responsibility for health and safety is given to specific people;

• there is a means for consulting and involving staff and safety representatives effectively at departmental or ward level;

• staff have enough information about the risks they face and the preventative measures to be taken;

• overall within the department or ward there is the right level of expertise and staff are properly trained; and

• access to specialist advice is taken as necessary, either from within or outside the organisation.

2.2.3 All staff are responsible for:

• taking care of their own safety and the safety of all others who may be affected by their acts;

• following all organisational rules, regulations and instructions to protect the health, safety and welfare of everyone affected by the organisation's services;

• knowing organisational policy and departmental, ward, or local health and safety working practices;

• not deliberately or recklessly interfering with or misusing any equipment provided for the protection of health and safety;

• knowing all emergency procedures including evacuation and fire precaution procedures relating to their place of work;

• attending health and safety training sessions and refresher courses provided by the organisation;

• following safe working practices and using safety equipment provided; and

• taking part in risk assessments and identifying safe working practices.

2.2.4 The Occupational Health and Safety Service (OHS) is responsible for:

• advising on legal responsibilities; and

• providing advice and support in tackling problems relating to health, safety and welfare at work.

2.2.5 Trade Unions/Professional Organisations and safety representatives are responsible for:

• participating in consultation mechanisms relating to health and safety issues at work;

• helping to develop local policy; and

• taking part in risk assessments and identifying safe working practices.

2.3 Ways of carrying out consultation and communication

The statutory Health and Safety Committee consults about and communicates health and safety plans. The members of this committee should reflect the characteristics of the employer and make sure that staff and managers have appropriate representation on the committee, which can include:

• safety representatives;

• line managers;

• a fire prevention officer;

• control of infection advisers;

• director responsible for health and safety;

• health and safety advisers;

• occupational health staff; and

• specialist advisers, for example, on issues such as manual handling, violence and aggression.

There may be a need for departmental committees to support the corporate committee if this is necessary, and departmental and staff meetings should have health and safety as a standing item on their agendas.

Other ways of spreading information on health and safety are:

• attaching information to:

• payslips;

• staff handbooks;

• departmental safety manuals; and

• notice boards;

• holding:

• departmental and ward meetings;

• corporate induction programmes;

• safety audits;

• training events and workshops on health and safety; and

• departmental training activities;

• through partnership forums;

• sending out newsletters;

• producing safety inspection reports; and

• through intranets.

The agenda for a health and safety committee should include, as a minimum:

• the Occupational Health minimum dataset;

• statistics on accidents and incidents and a review of any trends;

• a review of critical incidents;

• health and safety policies;

• risk assessment trends;

• reports from safety audit teams; and

• work-related sickness absence.

The systems an organisation has in place for health and safety need to involve everyone, with the Health and Safety Committee playing a central role. Responsibility for leading the health and safety agenda lies with Chief Executives of organisations. An Executive Director of the organisation will have responsibility and should be named in the organisation's health and safety policy. This person will report at least once a year to the organisation's Board on health and safety issues and will put forward (for approval) the coming year's health and safety agenda. The health and safety roles of senior and operational managers and staff must be clearly set out in the health and safety policy, and each operational manager must have a clear understanding of the area or site responsibility they have for health and safety. This will include responsibility for shared facilities such as meeting rooms.

Specialist advisers (for example, occupational health, fire safety, etc.) will support operational managers. We suggest that the nominated director convenes and chairs the Health and Safety Committee. This committee will monitor how policies are put in place by arranging regular audits and reports from committee members. The committee will communicate all health and safety issues to the organisation. The Health and Safety Committee will be linked to occupational health services, risk management structures and the Control of Infection Manager and other specialist advisers. Each health organisation needs to promote a positive health and safety culture, which features the following.

• Communication - either written or oral - to show that management are committed to a safe and healthy working environment.

• Competence - making sure that all staff are competent and that health and safety advice is readily available.

• Co-operation - to encourage people to get involved in risk assessments to achieve better results.

• Control - where representatives are clearly identified and resources secured.

This approach must be followed consistently across all parts of the organisation. It should also be 'interactive' and should constantly refresh the safety agenda.

2.4 Access to information

Safety representatives have the right to ask for documents relating to the workplace or individual staff (except for identifiable health records). An employer must provide relevant health and safety information unless this would:

• go against any acts of Parliament;

• be against the interests of national security;

• involve personal information about an individual without gaining that person's permission;

• cause harm to the organisation; or

• relate to legal proceedings.

NHSScotland employers should also use the principles of partnership in order to involve safety representatives at an early stage and include them in identifying safety issues. Sharing information with safety representatives, line managers and specialist advisers promotes an open way of working.

3. RISK ASSESSMENT

Assessing risk means carefully examining what, in our work, could cause harm to people. It involves weighing up whether we have taken sufficient precautions or should do more, both for work that is in progress and for work that is planned. So, it is about understanding what might happen and judging what to do as a result. An important step in this process is providing the information needed to allow managers to plan improvements in the health and safety standards within the organisation and then put them in place. A general risk-assessment framework, as necessary under the Management of Health and Safety at Work Regulations 1999, should follow the process set down in Box 2.

Employers need to carry out risk assessments for all hazards that arise from current activities, and, equally importantly, consider the measures that are needed to control the risks from new activities before they start.

The main principles of a risk assessment are to:

• eliminate risks altogether;

• tackle any risks at source;

• adapt work to the individual wherever possible;

• take advantage of technology wherever possible;

• give priority to measures which protect the whole workforce;

• make sure staff know what to do;

• review measures regularly; and

• train and involve all staff in risk assessment.

4. PRIMARY LEGISLATION

The Health and Safety at Work Act 1974 is the primary piece of legislation within the UK. The act is an 'enabling' act, often referred to as an umbrella act. (This means that Regulations can be introduced without the need for additional primary legislation.) This Act is supported by many other regulations and pieces of legislation, the most significant of which is the Management of Health and Safety at Work Regulations 1999. The crucial elements of these regulations lie in the requirement to have systems in place to manage health and safety. Using the technique of risk assessment to evaluate risk, to support planning and putting effective controls in place, helps to support such systems.

The Health and Safety at Work Act 1974 says that employers must, so far as is reasonably practicable, provide:

• a safe place of work;

• a safe working environment;

• safe equipment;

• safe systems of work; and

• sufficient information, instructions and training.

The Health and Safety at Work Act 1974 says that employers should have a written safety policy (see Appendix 4.A). The health and safety policy may form the document which provides the framework for a health and safety management system.

APPENDIX 4.A

Health and Safety Policy Statement

[Name of organisation] exists to provide healthcare services of high quality to the people of [Name of area]. We recognise that we cannot provide these services unless we ensure, as far as possible, freedom from risk to the health, safety and welfare of staff, and others affected by our work activities. This is a primary objective of [Name of organisation], and we prioritise it equally alongside other business and operating objectives.

The minimum acceptable standards of health and safety are those contained in legislation. It is our objective to improve on these standards.

We recognise that the prime responsibility for health and safety rests with our managers. This principle extends from the Chief Executive to first line supervisors. Managers and supervisors are directly accountable for the prevention of accidents, injuries and occupational illness, as well as damage to our property, within their area of responsibility.

This policy statement is supplemented by additional policies giving detailed arrangements for health, safety, welfare and related issues. Managers are responsible for bringing these policies to the attention of their staff.

All staff within [Name of organisation] are responsible for making safety at work a priority to protect themselves, their colleagues, patients, visitors and the interests of [Name of organisation].

The Occupational Health and Safety Service is responsible for advising managers and staff about their legal obligations and for advice and support in tackling problems relating to health, safety or welfare. [Name of organisation] has appointed a specialist advisor whose role is to help us meet our health and safety obligations.

As Chief Executive, I have overall responsibility for health and safety in [Name of organisation]. I have appointed the [Director of ...] as the Director with particular responsibility to oversee the implementation of this policy throughout [Name of organisation]. I will review the implementation of this policy annually and welcome suggestions for improvement.

Signed by

...................................................
[name]
Chief Executive
[date]

APPENDIX 4.B
References

Health and Safety Executive	Health and Safety Responsibilities of Directors, Safety Representatives and Safety Committees, Statutory Instrument 900, HMSO, London, 1997
Health and Safety Executive	Successful Health and Safety Management, HSE Books, London, 1997, ISBN 0717612767
National Audit Office	Health and Safety in NHS Acute Trusts in England - A Report by the Comptroller and Auditor General, HC 82, 1996/97, 22 November 1996, ISBN 0102626979
The Scottish Executive	Towards a Safer Healthier Work Place - an Occupational Health Strategy for NHSScotland, HMSO, Edinburgh, 1999