How might Covid-19 change occupational health?

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There are undoubtedly still pandemic challenges ahead but are there lessons that OH can already begin to learn from 2020? Practitioner Rosalyn Jones reflects on what, for her, have been some key learning points from what was an unprecedented year.

As an occupational health professional speaking to other practitioners, you don’t need me to explain the massive impact that Covid-19 had during the past year on work and people returning to work; we all lived it, after all.

But, looking back from the vantage point of being a year on from when the pandemic first emerged into the public consciousness – and with Covid-19 vaccines now providing at least some light at the end of the tunnel – here are my thoughts and reflections on how Covid-19 affected my practice and outlook and, potentially, occupational health more widely.

The emergence of Covid-19 and the changes to work and home life it brought was to me, at first, the cause of great confusion and bewilderment, as I am sure it was to many.

It seemed unreal back in February 2020 to be being told not to hug anyone or shake hands and keep your distance. Attending events such as the Health and Wellbeing at Work event at the NEC in Birmingham – one of the last such events before the UK went into its first lockdown (and, indeed, the NEC soon afterwards became a Nightingale Hospital) felt OK… just about.

Even then, there was still a sense that it was not the right place to be for us, that we should not be physically together or mixing in large groups. Will it happen again this year? I suspect not, at least probably not physically. I, for one, will be most disappointed, as it is a good place to network with colleagues, update your knowledge base, learn about employment law, health and wellbeing initiatives/policies, management and leadership, mental health and so (not to mention snaffle a few freebie pens, sticky pads, chocolates and stress balls). But hopefully it will return eventually.

New ways of working and of delivering OH

Annual updates and ongoing training initially stopped and online training and “meetings” became the norm. The use of Zoom and other video conferencing platforms became the new normal, even if initially they were a foreign concept to many. Lectures and web-based learning platforms have becoming easier to use (or maybe we have just become more familiar with them) and accessible even to those who are not comfortable or familiar with online formats. It is nice to know you can press the “mute” button and stay off camera during these events!

Sometimes, of course, it has been difficult when working from home to be fully composed in front of the camera; events around the house – children bursting in, partners wandering past in the background, parcels arriving at the door, pets jumping up – have all become familiar interruptions. I, I imagine like most OH practitioners, have also been only too aware that many occupational health skills do require some observational elements and competency elements, and so it has not been easy to do everything online.

Having said that, change and different ways of working can of course be a benefit. The past year has changed the world of occupational health, just as the pandemic changed the world generally. Our day-to-day practice and thinking has evolved; we have all had to change, review and reflect upon what we do. For me, it has it has highlighted:

1) The importance of self-care and looking after yourself. This is really important for us as practitioners; we need to practise health and wellbeing at work for ourselves as much as talk it about it and advise others. This has been especially important as some of the boundaries between home and work have blurred.
2) The relationship between day-to-day occupational health practice and day-to-day HR and management practice. This relationship can of course be positive in terms of highlighting examples of effective collaboration and intervention. But there was also the potential for things on occasion to turn negative, with the pandemic potentially amplifying some of the stresses and tensions that can exist within the relationships between occupational health and employers.
3) Improved IT skills. As touched on earlier, we have all had no option but to learn, embrace and get used to working with online platforms. For me, my trust in and confidence in using such technology has improved immeasurably over the past year.
4) Working from home has finally been recognised as a positive outcome. Many colleagues have for years been recommending the benefits of working from home for employees; we have had many meetings, have had to justify our reasonings for this recommendation and so on – often it was easy to feel you were banging your head against a brick wall.

But by forcing employers and employees alike to adjust so quickly and for so long – and for many it is by now almost a whole year away from the workplace – the pandemic changed attitudes overnight. It showed that home working can work and, in fact, can often be beneficial in terms of productivity, engagement and, indeed, health and wellbeing (if managed correctly).

It’s not right for everyone, and the past year has highlighted the limitations of home working too, especially in terms of issues such as isolation, social interaction and mental health. But the fact home working has become one ‘normal’ may yet be a positive long-term change for employers, employees and practitioners alike.

Indeed, for many of my colleagues, it has been nice to be able to show that occupational health was ahead of the curve in many of its processes, decision making and policies.

For example, as a profession we have certainly been ahead in recommending working from home, in developing and implementing health and wellbeing programmes and initiatives, in developing and implementing skin and hand hygiene initiatives and guidance, and in developing and implementing PPE guidance and implementation.

Keeping abreast of fast-changing guidance

As everyone scrambled to understand Covid-19 and what it meant, guidance on what we should and shouldn’t be doing was high on everyone’s agenda from early 2020 onwards. However, updates from bodies such as the Health and Safety Executive took their time in getting through. Indeed, there was often a sense that guidance from the HSE was quite woolly with regards to occupational health, especially in the context of health surveillance.

Health surveillance, after all, requires face-to-face appointments for some procedures and processes – such as spirometry and audiometry. Some occupational health services continued as normal, with appropriate PPE in place, yet others followed the guidance during the first lockdown of no face to face and stopped health surveillance. The cessation of this “bread and butter” aspect of what many OH colleagues/technicians deliver led to, for many, the drying up of much work, which was, of course, a concern.

It was also a concern to many that so much of the early guidance, least of all from the HSE and the Association of Local Authority Medical Advisors (ALAMA), notably appeared to direct the conclusions, via risk assessment, as a clinical decision. Will this come back to haunt OH practitioners via the legal system in the future? It is, I know, a question that has been asked by many.

Once the guidance was updated, which took several months, new processes were put in place and confidence grew to undertake more paper screen questionnaires, particularly with regards to spirometry and the reduction of aerosol transmission. Will paper screening and peak flow readings become the new norm? This could be an interesting discussion point or basis for research with regards to spirometry/peak flow readings and questionnaires.

Occupational health advice firmly in the spotlight

So, the crunch question: will the pandemic change occupational health as we know it?

My hope is that the current situation will, in time, lead to the cementing and embedding of good practice and how occupational health moves forward with its processes. So I am an optimist in this context.

More help and guidance from the HSE and governing bodies would be an improvement. It is felt, too often, that occupational health is a forgotten resource; after all, how many times (including by government ministers who should know better) is occupational health referred to as “OT”? Occupational health’s platform needs to be raised; it is felt even government does not know how important and knowledgeable we are as a profession and what we have to offer.

Because Covid-19 was so fast-evolving, and from a standing start of knowing nothing, there were ongoing challenges, too, with OH’s ability to advise employers effectively and authoritatively. For example, on returning to work with medical conditions, even with tools and guidance coming out and being updated regularly (and, to my mind, the ALAMA Covid risk assessment tool was helpful) it was extremely hard for practitioners, fundamentally, to give clear concise guidance to companies and employees.

The other side of the coin, however, was that the pandemic thrust health and safety, risk management, infection control, and health and wellbeing centre-stage for many employers during the past year as it had never been before. Where employers have had access to OH, our expertise and leadership has – potentially at least – helped them to recognise the value occupational health can potentially bring, as opposed just to the cost.

Another massive challenge that emerged especially in the wake of the first lockdown was that of the fearful or anxious employee. This was employees who might or might not have had a medical condition but were nevertheless anxious about their work and their potential exposure to Covid-19 through or via workplace.

The law firm Arnold & Porter has published valuable advice on the fearful employee. It argues the following: “The importance of good communication. Requests to work from home will not only be driven by convenience or a desire to spend more time with children, but they may also be spurred by a genuine fear on the employee’s part of contracting COVID-19 and/or exposing vulnerable people at home to the disease.

“It will be important for employers to be able to address these fears sensitively and to communicate clearly to employees the measures in place at work to protect health and safety. Employers should meet with employees to discuss their fears, help them readjust to coming back to work and remind anxious employees of the availability of any employee assistance programmes.”

A further challenge that, I suspect, may only just be beginning for occupational health is that of ‘long Covid’. This, as Occupational Health & Wellbeing highlighted in November, is long-running, recurring and often debilitating symptoms that some people can experience weeks, even months, after having otherwise recovered from the virus. In terms of return to work and rehabilitation, this is still largely an unknown quantity.

Mental ill health and anxiety is likely to be another long-term challenge for the profession. Many people, if not all of us, experienced some degree of anxiety during 2020. This may have been fear of the virus, the pandemic, the not knowing what can be done on a day to day basis, where you can go, who you can see. The lack of social interaction, hugging and so on has had a huge impact on all.

Many employers have continued as normal with appropriate PPE; it would be interesting to see if there are any studies on mental health and anxiety during this pandemic on individuals who have stayed at home, or even those who have shielded and/or continued working, versus those who continued working throughout the pandemic. Do they see the pandemic through different eyes and are their anxiety levels different?

Access to non-Covid care and elective procedures

Yet another, and potentially long-term, challenge may, I feel, be in terms of access to non-Covid medical services and elective procedures.

Many people have reported having great difficulty in talking to/accessing their GPs or being told their surgery is closed. Others have had hospital appointments cancelled, rescheduled and even re-cancelled. This, naturally, is frustrating, fuels fears and anxieties and can lead to poorer health outcomes when people do get seen, as the NHS has itself recognised and, through recent advertising campaigns, been working to address.

From an occupational health perspective, it does not help in terms of guidance for people returning to work, especially, if they require additional support or guidance from their primary or secondary care medical team before returning to work.

I know some esteemed colleagues within OH also have concerns about whether we are potentially exposing individuals to long-term health effects simply because guidance isn’t clear and/or in suspension, such as, again, some health surveillance and face-to-face activities. To reiterate HSE guidance on workers responsibilities: “Workers have a duty to take care of their own health and safety and that of others who may be affected by your actions at work.”

Therefore, clear education that occupational health can implement in the workplace should encourage/remind employees to take responsibility for their actions. Education through health and wellbeing programmes can enable employees to have skills and the confidence to report if they think their work practice/area is having a potential impact on their health.

Conclusions – time for change?

To sum up, occupational health is full of resources; as a profession we are competent, knowledgeable and professional clinicians. This needs to be better recognised within government and, in truth, within other parts of the medical and even nursing establishment.

Occupational health has a lot to offer. However the pandemic evolves or changes this year (or, hopefully, dissipates) NHS, private and public sector OH practitioners alike can be, and become, leaders in terms of education, mental health and wellbeing, PPE and health surveillance, telephone consultation, and working from home.

In terms of Covid 19, we can be at the forefront of workplace-based test, trace, analysis and, now (probably in time) vaccination. There is an opportunity to be had, I feel, for the profession that has come from the crisis that was last year.

For me, the confusion and bewilderment we all felt back in February 2020 changed to good old-fashioned, roll-up-the-sleeves, give-us-the-tools-to-deal-this professionalism. We got on with it then and we will continue to get on with it now. I am immensely proud to be a nurse in occupational health, proud to be part of the team, proud of all that the professional achieved in a most challenging year and, now, continues to achieve and deliver.

So, has anything changed? Yes, lots, of course. But I am confident that, with the knowledge and skills my occupational health colleagues have and are keen to share and bring to the table, occupational health will continue to evolve and be ahead of the wave.

References:
“What might OH expect from workplace health Green Paper?”, Occupational Health & Wellbeing, April 2020, https://www.personneltoday.com/hr/what-might-oh-expect-from-workplace-health-green-paper/

“Are you an employee”, Health and Safety Executive guidance, https://www.hse.gov.uk/workers/responsibilities.htm

Covid-Age, Covid-19 Medical Risk Assessment Tool, ALAMA, https://alama.org.uk/covid-19-medical-risk-assessment/

“Preparing for a Return to the Workplace: What Issues May UK Employers Face?”, Arnold & Porter, May 2020, https://www.arnoldporter.com/en/perspectives/publications/2020/05/covid-19-returning-to-work-in-the-uk

“Long Covid: how health and wellbeing benefits can make a difference”, Occupational Health & Wellbeing, November 2020, https://www.personneltoday.com/hr/long-covid-how-health-and-wellbeing-benefits-can-make-a-difference/