Occupational Health Services in eleven countries

1
Occupational Health Services in eleven countries
who are they? Contribution to Health for
All? Contribution to business development?
Contribution to an inclusive working life?
Problems ?

• A survey of Occupational Health Service
  organizations of
• Austria, Czech Republic, Denmark, Japan, Finland,
  France, Germany, Netherlands, Norway, Sweden, UK
  and UK/Scotland
• Special Issue of Policy and Practice in Health
  and Safety
• Chief Editor David Walters
• Guest Editor Peter Westerholm

2
Occupational Health Services in UK (Lawrence
Waterman)

• Problem 8 of private sector companies use
  some form of OH support. 2.5 mill. people on
  incapacity benefit in 2005.
• OH preventive services a patchwork quilt of
  public and private providers with widely varying
  approaches and service quality
• NHS tasks diagnosis and treatment not
  prevention
• Strong professional bodies of OH safety and
  health advisers (occupational medicine,
  occupational hygiene etc)
• Indications of traditional approaches in OH being
  largely ineffective. More of the same not likely
  to improve situation
• In 2000 key documents of HSC intentions
  Revitalizing health and safety and Securing
  health together demonstrating OH issues of
  central importance and providing basis for
  broad-based, multi-skilled team approach in
  addressing issues such as risk assessment,
  fitness for work and the rehabilitation and
  return to work of workers in ill health
• In 2001 establishment of Programme Action Group
  to follow up Revitalizing targets
• Birth of the OH Support model to be described as
  Workplace Health Connect by the HSE

3
UK (Lawrence Waterman) - Workplace Health
Connect programme (HSE 2005)

• A confidential service designed to give
  free,practical advice on workplace health, safety
  and return to work issues to smaller businesses
  in England and Wales
• An adviceline and supporting website giving
  tailored practical advice to callers, both
  managers and workers, on workplace health, safety
  and return to work issues
• A service that aims to transfer of knowledge and
  skills directly to managers and workers enabling
  them to tackle and solve issues themselves
• Set up in partnership with HSE and based around
  Adviceline/website and problem solving services
  available locally
• Bottom line messages
• - OH too important to leave to doctors
• - Health is not divisible healthcare
  is at its best holistic
• - To prevent harm is good, to promote
  wellbeing is even better

4
Developments in professional OH - UK
/Scotland(Ewan B. Macdonald Gabe Docherty)

• Taking the UK government programme Work, Health
  Wellbeing caring for our future one step
  further
• Scope of OH professionals work tasks widened
  beyond traditional workplace perspective to cover
  all population of working ages
• National OH Director appointed to implement Work,
  Health and Wellbeing strategies
• Center for Healthy Working Lives established for
  coordination of OH activities
• Healthy Working Lives action plans to be
  implemented on a large scale
• NHS/Scotland to support development of free
  advisory OH services to SMEs in industry
• Free Workplace visit, confidential Risk
  Assessment, WPHP needs assessment,

5
OHS/The Netherlands development from a
professional to a market market regime (André
Weel Nico Plomp)

• First period 1920 1980 Medical OH services.
  Drive from large industrial corporations and
  government to arrange medical services for
  workers
• Second period 1980 1994 Multidisciplinary OH
  services. Services became advisory bodies with an
  enlarged scope of tasks. Legal and economic
  experts on boards of management. Occupational
  physicians, occupational hygienists, safety
  engineers and organizational advisers on service
  teams.
• Third period 1994 1999 Commercial services.
  Service units transformed into business
  organizations. New commercial OH providers
  emerging and sharp competition on health market.
  Insurance companies and private investors enter
  stage as owners
• Fourth period 1999 2006 Lost monopolies
  Incentives to invest in rehabilitation and
  prevention strengthened. Return to work
  programmes and sickness absence management in
  demand by client companies.

6
OHS France on the rails from occupational
medicine towards occupational health (Gabriel
Paillereau)

• Arrangement of access to OHS services at
  compulsory for employers (who pay the costs)
• Dominant role of OH physician as advisor in all
  OH matters and adaptation or development of
  working conditions.
• Heavy load of annual medical examinations of all
  employees for assessment of work ability
• Cardinal changes following a Government decree of
  July 2004
• - medical examinations reduced to
  examinations every second year
• - OccupPhysicians dominance challenged in
  introducing a new professional category
  occupational hazard prevention operative
• - Occupational Health Plan 2005-2009
  implying strengthening of surveillance and
  monitoring functions and establishing new
  administrative central and regional structures
  for these tasks
• - Planning of regional multidisciplinary
  research centres
• Transformation has caused and is still causing a
  good deal of heat

7
OHS Finland (Matti Lamberg, Kaj Husman Timo
Leino)- the cornerstones

• Government development strategy for OHS during
  2002 2015
• OHS objectives to promote health and work
  capacity, to increase attractiveness of working
  life, to prevent and treat social exclusion and
  to provide functioning services and reasonable
  income security
• Employers obligation to organise and pay for
  preventive services for all workers. This may be
  done in different ways
• Employers are reimbursed for up to 50 of
  approved OH service costs from sickness
  reimbursement funds
• OHS main tasks to prevent work-related illnesses
  and accidents, to raise level of health and
  safety at work, to improve health, working
  ability and functional capacity of employees at
  all stages of their work careers, to promote the
  functioning of the work community
• Legislative regulation of management and
  surveillance of national plan and subsidiary
  plans addressing vocational training, competence
  development matters and research
• Finnish OH system based on firm political
  determined commitment

8
OHS Denmark Rise and fall of preventive
services (Anders Kabel, Peter Hasle and
Hans-Jörgen Limborg)

• Before 2001, OHS organisations/units provided
  services oriented towards OH needs of prevention.
  Basis Employers legal obligation. Structure
  Bipartite management of service units.
  Requirements of competencies and a quality system
  with programme for evaluations
• After 2001, consequent to post-election change of
  government
• - obligation of employers to organise OHS
  affiliation annulled
• - OH surveillance to be enforced by Labour
  Inspectorate issueing notice for improvement.
• - Notices for improvement may include
  referral to OH service units for assistance in
  complying with requirements of Labour Insp.
• - Companies with a Danish certificate on
  work environment or British OHSAS 1800 are exempt
  from inspections
• Earlier OHS units may be authorised to provide
  consulting services on Working Environment
  issues. On market also others offering similar
  type of services.
• Consequences Significant decrease of OHS service
  units in market and availability of OH
  professionals

9
OHS Sweden - Example of OHS unit Programme
Document- Chief Occup. Physician Johnny
Johnsson, StoraEnso Inc. Forss, Sweden)

• Prevention of work-related disease and illness
• Promotion and restitution of health
• Development of the working environment
• Improvement of work capacity, motivation and
  performance of staff
• Supplement jontly with company Safety Dept
• Support of business activities and strategies for
  Human Resource Management
• Client orientation and generation of added value
  for the company in general

10
OHS in European countries an ETUC view
(Laurent Vogel)

• OHS systems of Europe display wide differences in
  legislation and practices
• From trade union point of view many OHS systems
  do not deliver services matching expectations
  placed on them. Situation sometimes described as
  a Crisis of Confidence
• Coverage patchy - in most countries well below 60
  - excepting countries with legislative
  requirement for full or almost full coverage (Ex.
  Netherlands, Belgium, France, Finland,
  Luxembourg)
• Large groups not provided OHS SMEs, workers
  in insecure jobs, unorganized labour etc
• Multidisciplinarity - only modestly developed.
  Nordics, UK Spain
• Quality of OH preventive services often
  uncertain. Its surveillance inadequate
• Reservations regarding OHS professional
  independence
• Reservations regarding professional competence of
  external consultants and expertise in
  Occupational Health subject matter
• Reservations regarding collaboration and contacts
  between workers and preventive services

11
OHS Professionalism regardless of setting

• To have a Health agenda
• To be evidence-based or, at least,
  evidence-informed, in action and in all
  assessments
• To be aware of stakeholder expectations
• To help solve practical problems
• To communicate on OH issues with management,
  employees and trade unions and with other OH
  professionalsas appropriate
• To act in alignment to principles of Occupational
  Health ethics
• To take all opportunities in contacts to a
  life-long learning process
• To be transparent in all action and asessments

12
The Doctors Leadership Paradox

• A physician does not really need a boss at all
• If there should happen to be a boss anyhow, it
  must be another physician
• Bosses only do un-important, administrative
  things
• Colleagues who become bosses are no longer real
  physicians
• However, all physicians want to be bosses and
  have a highly developed sense of hierarchy.
• Source Chief Physician Carola Lemne MD
• Hospital Manager of Danderyds University Hospital
  Karolinska Institutet, Stockholm

13
PW_IOSH_Cardiff May 2007
A handshake should not go beyond the
elbow African proverb Quoted by Godfrey B
Tangwa, Yaounde University, Cameroon
14
OHS some features with implications for
professionalism

• OHS actor in a welfare system of considerable
  complexity with high dependence on other actors
  in concerted efforts
• Multiple stakeholder scenario in which no
  individual stakeholder is a priori regarded as
  most important of all
• Challenges on evidence based or research based
  knowledge and insights
• The three common models of guiding and managing
  human activity hierarchy, market and
  professional networks - exist in parallel
• Three domaines in co-existence OH
  professionals, management including management
  of OHS organisations and the domain of
  industrial relations. The demarcations of
  accountability and responsibility may become
  blurred all too easy.
• OHS work carried out in an ethically complex and
  demanding context
• Health professions globally involved in
  re-negociation of their societal and market
  targeted contracts
• Well trained graduates of universities pouring
  out and entering all sectors of labour market -
  including the health sector

15
Some determinants of OHS future

• Commitment and governance of the state with
  regard to OHS?
• Role models of OHS organisations. Agents of
  public health?, Commercially based organisations
  in a health market?
• Required competencies of OHS organisations in
  meeting expectations of the state or those of
  clients in the market?
• Conception of service quality and its development
  in OHS. Whose quality? Quality of
  customers/clients ? Quality as understood by
  health professionals? Quality implying
  cost-efficiency ?
• Implications of market mechanisms in OHS
  organizations operating as market actors?
• Strategies for evaluating the effectiveness and
  health impact of OHS?

16
Professionalism is to be visible and to inspire
trust
17
This is it

• Thank you for your attention !!!
• Peter Westerholm