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1. NEBOSH
International
Diploma
Unit IB
Element IB1: Managing
Occupational Health

2. Nature of
Occupational
Health
The Meaning of Health, Occupational Health and Well-
Being
Health
• A state of complete physical, mental and social well-
being, not merely the absence of disease or infirmity.
Occupational Health
• Occupational health is concerned with the
promotion and maintenance of the highest degree of
physical, mental and social well-being of workers in
all occupations.
Well-Being
• A state of being with others, where human needs are
met, where one can act meaningfully to pursue one’s
goals, and where one enjoys a satisfactory quality of
life.
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3. Categories of
Occupational
Health Hazard
Chemical
• Dusts, fibers, gases, vapours, etc. and the
associated hazards.
Physical
• Noise, vibration, radiation, heat, etc.
Biological
• Bacteria, fungi, viruses, mites, insects, etc.
Psycho-Social
• Stress, substance misuse, violence at work, etc.
Ergonomic
• Posture, workplace layout, etc.
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4. Prevalence of Work-Related Sickness and Types of
Ill Health
• In Great Britain, work-related ill health kills an estimated 13,000 people each year, of which work-
related cancer and lung disease account for over 90% of cases.
• Around 1.4 million people suffer from an illness (long standing as well as new cases) they believe
is caused or made worse by their current or past work.
• Around half of these cases are new cases of illness.
• The HSE collates ill-health statistics from a number of sources, such as RIDDOR, the Labour Force
Survey (LFS) and the Health and Occupation Reporting (THOR) network.
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5. Occupational Health
and Public Health
• There are strong links
between occupational health
and public health,
particularly in cases of
serious health issues which
will impact on individuals
and employers. Examples
include the H1N1 pandemic,
SARS near-pandemic,
asbestos and smoking.
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6. Study Questions
1. State the five categories of health hazard. Give an example of each.
2. Outline some of the main sources of data used to compile occupational ill-health statistics
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7. Management of
Return to Work
Basic Principles of the Bio-Psychosocial Model
The bio-psychosocial model is a way of considering
human ill health as being more than simply a case of
medical disease, but a combination of biological disease
and psychological response by the individual within a
social context.
Biological
• Physical or mental health condition.
Psychological
• Personal/psychological factors also influence
functioning.
Social
• Importance of the social context, pressures and
constraints on behavior and functioning.
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8. Fitness-to-Work
Standards
Fitness-to-work standards are standards that
workers are assessed against in order to ensure that
their level of fitness is acceptable for the specific
type of work that they are to do. For example, in the
UK, the statutory medical for Large Goods Vehicle
(LGV) drivers that they would have to undertake in
order to first obtain their license to drive on the
public roads, followed by five-yearly re-assessment
from age 45 onwards. Fitness-to work standards may
exist as part of a statutory requirement or,
alternatively, may be non-statutory industry
guidelines, good practice or some other non-
statutory code.
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9. Pre-Placement Health
Assessments
Pre-placement health assessments are
undertaken by a health professional as part of
the risk assessment process after a job offer
has been made. The pre-placement
assessment can consist of questionnaire
and/or medical examination. The results of the
assessment are that the worker is classified as
‘fit’, ‘unfit’ or ‘provisionally fit’ to do the do the
intended job.
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10. Managing Long-Term and Short-Term Frequent
Sickness and Incapacity for Work
Managing Short-Term Frequent Absence:
Short-term absence is where an employee is repeatedly absent for short periods of time, such as one
or two days. Key steps in managing this type of absence include:
• Proactive application of company policy.
• Return-to-work interviews to establish real reasons for absences.
• Procedures to deal with unacceptable absence levels and/or breaches of the policy.
• Use of trigger mechanisms to review attendance.
• Early involvement of occupational health professionals.
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11. Managing Long-Term
Absence
When discussing an employee’s return to work from long-term
absence, it may be appropriate to consider:
• Phased return.
• Lighter duties.
• Amended shift patterns.
• Re-training.
• A buddying system with a colleague.
• Risk assessment of the task and any adjustments identified
to prevent repeated absence.
Key principles:
• Identification of someone to undertake initial enquiries.
• Keeping in contact with the individual.
• Flexibility and restricting sick pay.
• Detailed assessment by relevant specialists.
• Health, occupational or rehabilitation interventions.
• Changes to work patterns or the environment.
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12. Key elements of managing sickness absence are:
• Recording sickness absence.
• Maintaining contact.
• Return-to-work interviews.
• Making use of professional advice.
• Planning and undertaking workplace adjustments.
• Agreeing and reviewing a return-to-work plan (rehabilitation programme).
• Co-ordinating the return-to-work process
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13. National Institute for Health and Care Excellence
(NICE) Guidance PH19
Summarizes the approach to the management of both types of absence as:
Stage 1 - Initial Enquiries
• By a suitably trained and impartial person, within 2-6 weeks of the absence starting, to determine the reason
for the absence, barriers to returning to work and the options for returning to work.
Stage 2 - Detailed Assessment
• Undertaken by relevant specialist/s as co-ordinated by a suitable case worker. This assessment has the same
aims as the Stage 1 enquiries and should identify the range of interventions and support services that will
facilitate return to work, perhaps with the agreement of a return-to-work plan.
Stage 3 - Interventions and Services
• The delivery of the various interventions and services identified by the detailed assessment.
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14. Vocational Rehabilitation
Vocational rehabilitation is concerned with helping someone with a health problem to stay at, return to
and remain in work.
Benefits of Vocational Rehabilitation
There are benefits from rehabilitating workers back into the workplace, for:
Employer Benefits
Simple measures to prevent and manage ill health can lead to:
• Decreases in employee absences.
• Improved productivity and competitive edge.
• Healthy working environments contributing to reduced employee absence through sickness and stress.
• Employees feeling cared for and so are often more satisfied and perform better, which can have the
effect of reducing staff turnover and increasing productivity.
• Getting employees back into work after illness which reduces the loss of experienced staff and the cost
of recruiting new staff.
• Being known as an organisation that cares about employees, which can enhance business reputation and
help to attract staff and customers.
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15. Vocational Rehabilitation
Employee Benefits
• Better physical health.
• Better mental health.
• Increased financial security.
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16. Overcoming Barriers
The bio-psychosocial model can be used to identify barriers to the rehabilitation of ill workers and has been used
in the rehabilitation of workers with MSD and other common work-related conditions:
Biological Barriers
• The physical disease, ill-health condition, disability or mental health condition that the worker might be
suffering from.
Psychological Barriers
• Fear of returning to work.
• Concern over the opinions of colleagues.
• Anxiety about future prospects.
Social Barriers
• Access to and from the workplace.
• Appropriate sanitary conveniences.
• Workstation design and layout.
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17. Risk Assessment
Risk assessments may need to be carried out or reviewed in the light of a worker’s return to work,
to ensure that the hazards and risks associated with their work have been properly considered. A
Personal Emergency Evacuation Plan (PEEP) may be necessary for fire evacuation.
Role of Other Disciplines and External Agencies
• Many external agencies offer help and support both for employers and employees during the
vocational rehabilitation process.
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18. Study Questions
3. Give three examples of occupations where there are likely to be defined fitness-to-work
standards.
4. Outline the meaning of vocational rehabilitation.
5. What is the bio-psychosocial model?
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19. Managing Occupational Health
Occupational Health Services
Occupational health services are responsible for advising on the requirements for establishing and maintaining a
safe and healthy working environment, which will facilitate optimal physical and mental health, and the
adaptation of work to the capabilities of workers in the light of their state of physical and mental health.
Occupational health services requires the involvement of a range of professionals including physicians, nurses,
occupational hygienists, ergonomists and safety engineers.
An example might be:
• The recognition of a particular health effect by a worker, safety representative, nurse or doctor.
• Diagnosis of the illness and treatment by a nurse or doctor.
• Discovery of the environmental cause by a hygienist.
• Implementation of controls by a safety engineer, hygienist or ergonomist.
Occupational hygiene involves:
• Recognition/identification - identifying those factors that may cause harm.
• Measurement - determining who is affected and by how much.
• Evaluation - making a judgment on the risk posed.
• Control - putting measures in place to reduce or eliminate the risk.
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20. Role and
Benefits of
Occupational
Health Services
✓Statutory compliance with health and safety and equal
opportunities legislation.
✓Reduction in the absence rates and number of days lost
through ill health and the resulting costs associated with
absence.
✓Improved management of rehabilitation and return-to-work
processes.
✓Early recognition of work-related health hazards, allowing
for improved identification, assessment and control.
✓Improved management of work-related ill health, allowing
for earlier and better treatment and consequently better
recovery and minimization of ill health.
✓Reduction in ill health compensation claims.
✓Better screening prior to employment to allow matching of
personal characteristics and job requirements.
✓Improved worker morale.
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21. Make-Up and Functions of a Typical Occupational
Health Service
Occupational Health Physician
• Concerned with the diagnosis and assessment of health hazards and stress at work.
• Specialist branch of the medical profession.
• Certain types of work can only be performed by an occupational health physician.
Occupational Health Nurse (or Adviser)
• Specialist branch of the nursing profession.
• Rarely involved in direct treatment of injury or ill health.
• Concerned with proactive prevention of disease and ill health and management of treatment and care
programmes.
Occupational Health Technician
A developing role:
• Some aspects of health surveillance under supervision.
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22. Occupational Hygienist
Is concerned with the measurement of risk and interpretation of results, making use of special
equipment and instruments:
• Measurement of airborne contaminants, and comparing the results with those published in
standards (e.g. EH40).
• Measurement of heat, noise and other pollutants.
• Measurements on ventilation systems and other environmental control devices to ensure they
operate at optimum performance.
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23. Determining Competence within
Occupational Health
There are minimum standards of qualification and registration for:
• Occupational health doctors.
• Occupational health nurses.
• Specialists such as audiometricians.
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24. Typical Services Offered by an Occupational
Health Service
• Pre-employment and pre-placement screening.
• Health surveillance.
• Return-to-work rehabilitation programmes.
• Sickness absence management.
• Counselling.
• Risk assessments.
• Health education and promotion campaigns.
• Treatment services.
• Management of first-aid and immunisation programmes.
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25. Health Assessment and Health Surveillance
General health assessment:
• Assessment of an individual’s fitness to carry out the general duties or specific tasks associated
with work.
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26. Health Surveillance
Health surveillance is a more specific assessment of a worker’s medical fitness that focuses on one specific
aspect of health in relation to a particular hazard or hazard group. The intention of health surveillance is to
determine a worker’s state of health with regards to the hazard and then to track that aspect of their health
forward in time through repeat assessments.
Health surveillance is only required where the following criteria are met:
• there is an identifiable disease or adverse health condition related to the work concerned; and
• valid techniques are available to detect indications of the disease or condition; and
• there is a reasonable likelihood that the disease or condition may occur under the particular conditions of
work; and
• surveillance is likely to further the protection of the health and safety of the employees to be covered.
Health surveillance is normally provided where there is a clear statutory duty under specific health and safety
legislation.
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27. Health Needs Assessment
Health Needs Assessments (HNAs) can be used to identify the occupational health priorities that are
of concern to the workplace, so that an appropriate occupational health service response can be
planned and implemented.
Key stages in carrying out a health needs assessment:
• Stage 1: Obtain senior management commitment and resources.
• Stage 2: Decide on the method of data collection: survey, interviews, focus groups.
• Stage 3: Consider the physical and psychological demands of the job, the individual’s health
effects on the job and adverse health effect of the job on the individual.
• Stage 4: Gather the data.
• Stage 5: Analyse the data.
• Stage 6: Develop and implement the workplace health and well-being strategy.
• Stage 7: Review, evaluate and monitor progress.
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28. Standards in Occupational Health
Provision
The Safe, Effective, Quality Occupational Health Service (SEQOHS) scheme is a set of
standards and a voluntary accreditation scheme for occupational health services in the UK
and overseas. The scheme is managed by the Royal College of Physicians of London (UK)
and provides evidence to a service user that the occupational health provider meets
acceptable standards.
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29. Study Questions
6. Outline the typical functions of an occupational health service.
7. When is health surveillance a requirement of good practice?
8. What is the purpose of carrying out a workplace health needs assessment?
9. What is SEQOHS?
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30. Answers
1) State the five categories of health hazard. Give an example of each?
• Physical (e.g. noise), chemical (e.g. lead), biological (e.g. Legionella), psycho-social (e.g. stress) and ergonomic
(e.g. repetitive handling).
2) Outline some of the main sources of data used to compile occupational ill-health statistics?
• RIDDOR – which requires the reporting of specific occupational diseases by the employer.
• Labour Force Survey (LFS) – is a national survey of private households in the UK each quarter. The survey is
managed by the Office for National Statistics.
• The Health and Occupation Reporting (THOR) network – a voluntary surveillance scheme for work-related ill
health under which specialist doctors systematically report all new cases that they see in their clinics.
• The Industrial Injuries Scheme – administered by the Department for Work and Pensions (DWP) to compensate
workers who have been disabled by a prescribed occupational disease.
• Death certificates – as a source of deaths from asbestos-related and other occupational lung diseases.
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31. Answers
3) Give three examples of occupations where there are likely to be defined fitness-to-work standards?
• Occupations requiring specific fitness-to-work standards include:
• Vehicle driving, e.g. forklift trucks (FLT), Large Goods Vehicles (LGV), cranes, buses, trains, etc.
• Working in confined spaces.
• Emergency service workers.
• Night shift workers.
• Divers.
• Working at heights.
4. Outline the meaning of vocational rehabilitation?
Vocational rehabilitation is the process of returning a worker back to meaningful work as a way of aiding their
recovery and return to health following a period of physical or mental ill health. It can also be a way of improving
the health of an individual through getting them in to work and keeping them in work.
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32. Answers
5. What is the bio-psychosocial model?
The bio-psychosocial model is a way of considering ill health as being more than simply a case of a biological
disease.
It takes a more holistic view that includes biological, psychological and social aspects of the condition:
• Biological refers to the physical or mental health condition.
• Psychological recognises that personal/psychological factors also influence functioning and the individual must
take some measure of personal responsibility for his or her behaviour.
• Social recognises the importance of the social context, pressures and constraints on behaviour and functioning
6. Outline the typical functions of an occupational health service?
• Pre-employment screening – general health assessment of both general fitness and specific job fitness.
• Health surveillance – routine checks or tests focusing on specific aspects of health as a result of exposure to a
specific hazard.
• Return-to-work rehabilitation programmes – management of the rehabilitation of specific workers back into
work.
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33. Answers
• Sickness absence management – recording and analysis of absence data and involvement in sickness absence
procedures.
• Counselling – formal or informal listening service with in-house or external referral as required.
• Risk assessments – involvement in some general workplace assessments and conducting specific assessments,
such as those for pregnant women.
• Health education and promotion – running campaigns and providing support on various public health issues.
• Providing advice – to employers and workers on specific health issues and queries.
• Treatment services and first aid – such as management of main treatment facility and assessment and
management of first-aid provision.
7. When is health surveillance a requirement of good practice?
Health surveillance is required where the following criteria are met:
• there is an identifiable disease or adverse health condition related to the work concerned; and
• valid techniques are available to detect indications of the disease or condition; and
• there is a reasonable likelihood that the disease or condition may occur under the particular conditions of work;
and
• surveillance is likely to further the protection of the health and safety of the employees to be covered.
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34. Answers
8. What is the purpose of carrying out a workplace health needs assessment?
A workplace Health Needs Assessment (HNA) is carried out to identify the occupational health priorities that are
of concern to the workplace so that an appropriate occupational health service response can be planned and
implemented
9. What is SEQOHS?
SEQOHS stands for Safe, Effective, Quality Occupational Health Service and is a set of standards and a voluntary
accreditation scheme for occupational health services established by the Faculty of Occupational Medicine. It
provides an assurance to service users that service providers achieve the minimum standards established under
the scheme.
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35. References
• Sources used to compile this presentation.
1. A Guide to the NEBOSH International Diploma in Occupational Safety and Health – Unit IB: Hazardous
Substances/Agents
2. Unit IB/B - NEBOSH Diploma Revision Guide
I would highly recommend to buy RRC Text Book & RMS Revision Guide to full understand the concepts of this
Element i.e IB1
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