Fitness For Role: Staying Healthy Whilst Working Longer
UK government demands have necessitated significant changes within public services brought about by a legal obligation to balance a significantly decreased budget. Changes to pension means organisations have to manage the retention of an older working population with increasing physical and mental challenges, an unprecedented task within such a demographic group.
As a direct result of these demands to our service, the Occupational Health Unit (OHU) and other support services have had to change significantly to fully align with the organisation’s strategic intent. The service delivery model within OHU now focuses on efficient and economic preventative approaches as opposed to the traditional, reactive treatment service. Whilst rehabilitation back into the workplace following illness of injury is still a vital occupational health function, the service has adapted by using methods such as education and health promotion designed to reduce, and ideally prevent, sickness absence in the first place (Hinckley, 2015).
The post-industrial society we live in today suggests increased activity outside of work is necessary to sustain the appropriate level of health and fitness required for role and to remain in employment. Whilst firefighting cannot be described as a sedentary job, the significant decrease in house fires (Knight, 2013) and the increase in prevention-based activity has resulted in an overall reduction in physical activity in the workplace. This shift has contributed to a change in OH case load, and different demands on support services across the organisation.
Evidence suggests that there are now fewer musculoskeletal disorders (MSD), but more presentations of mental ill-health, such as anxiety and depression. The reasons for this trend are complex, but it is hoped that work done both nationally and at a local level within the organisation have contributed to breaking down the barriers and stigma associated with mental ill-health (MIND, 2015). Poor levels of health and wellbeing, including low morale and motivation, impact on productivity and employee retention.
It is evident that a holistic, multidisciplinary team (MDT) approach to health, fitness and wellbeing is required. This will often prevent a very simple condition developing into a very costly outcome, and provides evidence that the biomedical model is outdated and needs to be challenged. The biopsychosocial (BPS) model of care, first championed by Engel (1977), provides a fit for purpose framework through which a truly holistic package of support may be delivered, and encompasses a wider approach to the biological, psychological and social aspects of health and wellbeing.
It is therefore imperative that, irrespective of the backgrounds and experience of the MDT, the practitioners adopt the same principles in order to provide consistent care. Utilising individual case management, with consideration and recognition of all contributory factors to ill-health – including obstacles to recovery – will identify behaviours that affect the outcome and will provide the appropriate level of care and support as soon as possible.
OH teams consist of nurses, technicians, physiotherapists, psychologists, and counsellors, but have historically been led by physicians. In recent years, the role of fitness adviser (FA)
has developed within most fire services nationally. FAs work closely with clinical staff, often with responsibility for fitness level assessments and prescriptive exercise programmes. However, there is more scope for FAs, with an enhanced understanding of the BPS model, to work as part of the MDT in all aspect of health in order to promote a speedy and safe return to work. The demise of the obsolete biomedical model also provides an opportunity to improve OH services by devolving responsibility for clinical leadership away from physicians and placing it in the hands of other MDT members who embrace the BPS model’s holistic viewpoint.
The total number of working days lost due to MSDs in 2013/14 was 8.3 million, an average of 15.9 days per case. (HSE 2015) In 2014 the government stated that employers’ faced a yearly bill of around £9 billion for sick pay and associated costs, with individuals missing out on £4 billion a year in lost earnings’. (DWP 2014) Occupational back pain accounts for a large proportion of these disorders, a condition know to have a significant psychological component. Success has been evident when using the BPS model in managing back pain; for example, the inappropriate use of such terms as “chronic” pain can often influence an individual’s own perception of their condition, convince them that it is a lot more serious than it is, and thus dramatically influence the outcome by slowing recovery.
It is well researched that activity and mobility promotes recovery, but a more holistic BPS approach is required to address the psychological components, such as motivation and morale, required for successful rehabilitation.
OH services and employees must evolve together to meet the changing needs of their organisation, embracing the factors required to maintain a high standard of health, fitness and wellbeing. This partnership, with a change-ready workforce mindful of the responsibility for their own health, will augment the resilience required to meet the future demands on an ageing workforce.
DWP (2015). A million workers off sick for more than a month. Department of work and pensions. Online www.gov.uk/ government/news/a-million-workers-off-sick-for-more-than-a-month. Accessed 21/08/15
Engel G L (1977). The need for new medical model: “A challenge for biomedicine”. Science 196; pp.129-136
Hinckley P (2015). Reshaping our Occupational Health Service. WMFS Birmingham
HSE (2015). Musculoskeletal Disorders in Great Britain 2014. Online at wtistics/causdis/musculoskeletal/msd.pdfww.hse.gov.uk/sta. Accessed 21/08/15 Knight K (2013). Facing the future: Findings from the review of efficiencies and operations in fire and rescue authorities in England (The Knight Report) DCLG, London. Mind (2015). Online at www.mind.org.uk. Accessed 21/08/15
Article provided by: Paul Rudge – Occupational Health. West Midlands Fire & Rescue Service.