Ill-health retirement among healthcare workers in the Southern Health Board of the Republic of Ireland

AIM: To determine the incidence rates, trends and medical causes of ill-health retirement (IHR) among different occupational classes in the Southern Health Board (SHB). METHODS: The 14 702 permanent employees of the SHB were divided into six occupational classes based on socio-economic status and occupational demands. The occupational classes were compared for incidence rates of IHR, age at IHR, years of service and medical causes of IHR. The total group of employees was used as the standard for statistical comparison. Incidence rates were compared using standardized IHR ratios (SIHRRs). Medical causes were compared using proportional ill-health retirement ratios (PIHRRs). RESULTS: Three hundred and three employees were granted IHR from 1994 to 2000.The overall incidence rate of IHR was 2.9 per 1000 employees per annum. The highest SIHRRs occurred in male maintenance staff at 345 (CI: 221-513) and female support staff at 158 (CI: 123-201). With regard to age and years of service, IHR peaked at a time that coincided with enhancement to pension entitlements. The common causes of IHR were musculoskeletal disorder (38%), mental illness(17%), circulatory disorder (12%) and neoplasia (8%). PIHRRs did not vary significantly between the classes. CONCLUSION: IHR was more common among manual healthcare workers. The structure of the pension scheme appeared to influence the timing of IHR. Occupational class did not appear to influence the medical causes of IHR.     

Ill-health retirement of schoolteachers in the Republic of Ireland

BACKGROUND: To investigate the epidemiological profile and medical causes of ill-health retirement (IHR) of teachers in the Republic of Ireland. METHODS: Medical file review of teacher IHR in Irish primary and secondary schools, between 2002 and 2005 inclusive. RESULTS: In all, 466 employees were granted IHR between 2002 and 2005.The rate of IHR was 2.7/1000 teachers per annum, with an average age at IHR of 52 years. The most common reasons for IHR were mental disorders (46%), cancer (19%), circulatory (14%) and musculoskeletal disorders (10%). CONCLUSIONS: The rate of IHR among Irish teachers is similar to that of other occupational groups, with psychiatric conditions, cancer and circulatory diseases as the principal causes.     

The involvement of occupational health services prior to ill-health retirement in NHS staff in Scotland and predictors of re-employment

OBJECTIVE: To assess the process, causes and outcomes of retirement because of ill-health in NHS staff in Scotland. Particular areas to be investigated include the involvement of occupational health services, access to rehabilitation and redeployment, current health, whether working again and to identify predictors of re-employment. METHOD: An ill-health retirement (IHR) questionnaire was mailed to 863 NHS staff awarded IHR benefits by the Scottish Public Pensions Agency between April 1998 and March 2000. RESULTS: In all, 49% of the 863 postal questionnaires were returned. The most common reasons for retiring were diseases of the musculoskeletal system (38%) and mental disorders (21%). Seventy-one percent of the participants reported their ill-health was partly or completely work related and 29% not work related. Ninety-two percent of NHS staff had attended an occupational health department prior to IHR. Twenty-three percent of participants had no contact with their line manager during their illness prior to retiral. Eighteen percent of individuals were offered the opportunity of working part-time and 15% offered alternative work. Seventeen percent of participants have obtained other work. Predictors of re-employment after IHR were: medical condition, managerial responsibility, improvement of health, wanting to work again, occupation and age at retirement. CONCLUSION: This is the first comprehensive study investigating NHS staff experiences of IHR in Scotland. This study illustrates the need for improved support and rehabilitation for ill-health care workers and that there is the potential to reduce levels of ill-health retirement.     

Ill-health retirement: national rates and updated guidance for occupational physicians

BACKGROUND: Advising on ill-health retirement is an important role of most practising occupational physicians. In recent years, the eligibility criteria and process for gaining early retirement benefits have changed in many pension schemes in the UK. AIM: To investigate the variation in rates of retirement due to ill-health in National Health Service (NHS) Trusts and Local Authorities and to update previously published guidance on ill-health retirement with specific reference to pension schemes with eligibility criteria that include permanence of incapacity due to ill-health. METHODS: Rates of retirement were calculated for 222 NHS Trusts and 132 Local Authorities with more than 1500 employees. Literature searches and consensus statements by the authors. RESULTS: Rates of retirement were widely distributed in the NHS Trusts and Local Authorities. The median rates of retirement were 2.11 (IQR 1.37-2.91)/1000 active members and 4.10 (IQR 3.01-6.10)/1000 employees, respectively (P<0.001). Difficulties in the doctor-patient relationship and in ascertaining the true functional ability of some patients were identified. CONCLUSION: There continues to be marked variation in rates of early retirement due to ill-health within and between organizations that warrants further investigation. The general and specific guidance that appears as an appendix in Supplementary data to this paper should help occupational physicians to make equitable recommendations when assessing applications for early retirement benefits and fitness to work.     

Ill-health retirement: a survey of decision making by occupational physicians working for local authority fire and police services

AIMS: To investigate the effect of qualifications, experience and service on ill-health retirement decisions made by police force and fire brigade medical advisers. METHODS: Doctors advising UK fire and police authorities attending a conference were given 16 case summaries from experienced fire and police advisers and asked to predict the outcome in terms of return to work or ill-health retirement. The answers were scored by assessing whether the outcome predicted by the participant agreed with the case setter. Correlation coefficients were calculated and a kappa coefficient was determined for assessing inter-participant variation. RESULTS: Forty-seven doctors attended, 44 participated and the responses of 39 (86%) were analysed. Over half the doctors participating had held their post for less than 5 years. The majority (>50%) agreed with the case setter in 11 case summaries and in five cases the agreement was strong (>75%). The majority disagreed in five cases, with < or =80% dissenting in three cases. There was wide variation in the inter-participant variation (kappa = -0.333 to +0.5) but the total agreed score correlated significantly (P < 0.05) with experience and service as a fire or police adviser (kappa = 0.33) and ill-health retirement agreement correlated significantly with experience (kappa = 0.49). There was no correlation between the level of qualification and total correct decisions. CONCLUSIONS: Whilst we found general agreement overall, our results suggest that there is inconsistency in ill-health retirement decision making by police and fire service medical advisers in certain cases. Experience appears to improve the likelihood of agreement in decision making.     

Return to work after ill-health retirement in Scottish NHS staff and teachers

BACKGROUND: Most major public and private sector pension schemes have provision for ill-health retirement (IHR) for those who become too ill to continue to work before their normal retirement age. AIM: To compare the causes, process and outcomes of IHR in teachers and National Health Service (NHS) staff in Scotland. METHODS: A total of 537 teachers and 863 NHS staff who retired due to ill-health between April 1998 and March 2000 were mailed an IHR questionnaire by the Scottish Public Pensions Agency. RESULTS: The response rate for teachers was 53% and for NHS staff 49%. The most common cause of IHR was musculoskeletal disorders for NHS staff and mental disorders for teachers. Teachers retired at a younger average age than NHS staff. Ninety-two per cent of NHS staff but only 11% of teachers attended occupational health services (OHS) prior to IHR. Eighteen per cent of NHS staff and 9% of teachers were offered part-time work by their current employer in response to their ill-health. Fifteen per cent of NHS staff and 5% of teachers were offered alternative work prior to retirement. Seventeen per cent of NHS staff and 36% of teachers subsequently found employment. Multiple logistic regression analyses showed the following variables as independent predictors of subsequent employment: occupational group, age group, sex, managerial responsibility and cause of IHR. CONCLUSIONS: Return to work after IHR suggests that some IHR could be avoided. Teachers had a higher rate of return to work and much less access to OHS.     

Occupational hygiene science and its application in occupational health policy, at home and abroad.

This paper examines the role of occupational hygiene in the overall framework of occupational health. It draws attention to the unique combination of required individual science subjects, and to the way in which occupational hygiene science contributes to the practice of occupational hygiene in the real world. It focuses in particular on occupational exposure standards. The paper provides, as an example, the specific case of occupational aerosol exposures. It is here that scientific research has made a notable impact on standards and led to a considerable degree of international harmonization. Finally, some broader insights into occupational exposure standards are given, based on experience gained during visits to a number of contrasting countries. The similarities and differences between the various national approaches help indicate what is generic in how standards are set. Such insights provide a basis for further international harmonization in the future. It is concluded that occupational exposure standards appear to be most effectively applied in countries where there are strong occupational hygiene cultures.     

Audit of a pre-employment risk identification form

A risk identification form was introduced as part of SouthmeadHealth Services NHS Trust's pre-employment procedure. Its purposewas to allow occupational health nurses to identify employeeswith specific occupational health needs. One hundred employees'risk identification forms were studied and a comparison madebetween the manager's assessment and that of an independentoccupational health nurse's assessment based on job title alone.The actual risks involved in the post were identified by theemployee after 1 month employment, together with an occupationalhealth nurse from Southmead NHS Trust. There was a greater agreementbetween the managers' assessments and the actual risks identified(range 83–100%), than between the independent nurse'sassessments and the actual risks identified (range 59–100%),in all categories other than driving. The sensitivity of themanagers' risk assessments were higher than that of the independentnurse in all categories and the positive predictive value ofthe managers' risk assessments were higher than that of theindependent nurse in all but two categories.     

Occupational mental health: a brief history

This paper describes the development of occupational mental health in the United Kingdom. It looks at the increasing involvement of occupational health staff in this aspect of the workplace and the role played by organizational psychologists in exploring the relationship between work and mental well-being. It provides a background for the reviews of current knowledge described in the other papers in this issue of Occupational Medicine.     

Pre-employment health assessments for food handlers: a survey of occupational physicians in the food industry

The format of pre-employment health screens within the food industry varies considerably. The aim of this study was to produce a consensus on the content of a screen that will enable employees to handle food with minimum risk to the product and employee. A questionnaire was sent to the 63 members of the Food Industry Medical Association, of whom 45 (71%) responded. As a minimum, a questionnaire completed by the applicant is thought to be sufficient. Applicants reporting health problems need to be assessed by a health professional.     

Perception and provision of occupational health services in the UK

BACKGROUND: There is difficulty in defining occupational health services among stakeholders of the service. Concurrently, there are concerns about the state of occupational health provision in the UK. AIMS: To determine stakeholders' perception of the services that occupational health encompasses and the level as well as the rationale behind the provision of these services. METHODS: The research was undertaken as a postal questionnaire survey of the FTSE 350 companies and selected public sector organizations in the UK. This was followed up by telephone calls to a random selection of non-respondents to obtain non-respondent data. RESULTS: There is a difference in opinion among managers and occupational health professionals about the services provided by occupational health. Taking into account non-respondent data to partially adjust for overestimation biases, the level of provision of occupational health services among the FTSE 350 companies is 69% and in public sector organizations is 95%, giving an average provision of 72%. Sixteen per cent of respondents thought there was a trend towards outsourcing of services. The most frequently cited reason for provision of an occupational health service was that it was for the benefit of employees. CONCLUSIONS: There remains room for improvement in the level of occupational health services provision in large UK private sector organizations. By bridging the gap between the different stakeholders' perceptions of the remit and benefits of the service, a higher level of provision in the private sector similar to that of public sector organizations can be achieved.     

A health promotion programme for oil refinery employees: changes of health promotion needs observed at three years

The main aim of this three-year follow-up study was to evaluatethe long-term effects of a workplace health promotion interventionprogramme offered by the Neste Oyj corporation's occupationalhealth service. Another aim was to study factors associatedwith changes in health promotion needs. These were assessedusing information obtained by means of questionnaires and laboratorymeasurements. The target areas assessed were physical activity,musculoskeletal problems, dietary habits, obesity, blood pressure,serum lipids, smoking, quality of sleep and mental well-being.Participants from one oil refinery were offered special healthpromotion counselling, while those from the other oil refinerystudied received only their personal results, written informationand instructions. Evaluation of the changes in needs was mainlybased on comparison of the results of two examinations performedwith an interval of three years. Effects of special health promotioncounselling were observed in the target area of physical activity.Elimination of certain health promotion needs was seen in bothgroups in all of the target areas. The most extensive changeswere seen in the target areas of musculoskeletal symptoms, dietaryhabits, blood pressure and mental well-being. Basic education,occupational status and age-group, as well as the value of tendinghealth were frequent variables explaining the reduction in theneed for health promotion activities. Worker participation inhealth promotion counselling activities provided by occupationalhealth services can be high, as in this study in which the participationrate was 90% and the drop-out rate during the three years only10%.     

Adherence to mental health guidelines by Dutch occupational physicians

BACKGROUND: In 2000, the Dutch Association of Occupational Physicians published a national guideline for the management of employees with mental health problems. OBJECTIVES: To examine predictors of adherence to this guideline by Dutch occupational physicians (OPs). METHODS: Using the Theory of Planned Behaviour, a questionnaire was developed about self-reported guideline adherence of OPs and possible predictors of this behaviour. A total of 165 OPs were approached to complete the questionnaire and registration forms of first consultations of workers with mental health problems. Performance indicators based on the guideline were developed to calculate performance rates of guideline adherence by OPs. RESULTS: Eighty of 165 (48%) OPs approached completed the questionnaire. Fifty-six OPs returned one or more registration forms, totalling 344 consultations. On a five-point Likert scale, ranging from never (1) to always (5), the mean score on self-reported guideline adherence was 2.35, compared to a mean score of 4.06 on the intention to comply with the guideline. The mean performance rate of OPs ranging from 0 to 2 was 1.27 on diagnosis and 0.60 on guidance. No relation was found between self-reported guideline adherence and performance rates. Self-reported guideline adherence correlated significantly with perceived behaviour control (r = 0.48, P < 0.05), subjective norms (r = 0.33, P < 0.05) and positive job stress (r = 0.35, P < 0.05). CONCLUSIONS: Guideline adherence by Dutch OPs lags behind its acceptance. Further implementation efforts need to focus on diminishing barriers and enhancing social norms of OPs to work according to the guideline.     

Methods to persuade higher management to invest in health promotion programmes in the workplace

This study was conducted to find effective methods to persuadehigher management to invest in workplace health promotion (WHP)programmes. The study included 639 occupational health professionalsselected from the directory of the Japan Society for OccupationalHealth. A questionnaire survey was mailed to health professionalsthroughout Japan in 1992, and all respondents were asked toidentify themselves. We received 242 replies, which constituteda response rate of 38%. Eighty-one per cent of the respondentshad attempted to persuade higher management to implement a WHPprogramme. Health professionals frequently presented their caseto higher management through a safety and health committee (SHC),and advice provided at the SHC was perceived to be the mosteffective method by occupational nurses (ONs) and safety andhealth supervisors (SHSs). This method was rated second by occupationalphysicians (OPs), who thought recommendations from OPs stipulatedby the Industrial Safety and Health Law to be most effective.Statistics on medical examinations constituted the data mostfrequently used to persuade higher management, followed by reportson worksite inspections and health care plans. Nearly 90% ofOPs and 80% of ONs and SHSs felt that the above methods werefairly successful.     

Toothless tests: associations between the results of routine screening medical examinations and ill-health retirement of firefighters in west central Scotland

The final routine medical examinations (RME) of 526 full-time firefighters, all male, retiring from Strathclyde Fire Brigade in the decade beginning 1 January 1985 were studied to determine differences between the results of the 328 taking ill-health retirement (IHR) and the 198 completing maximum service (MS). Mean ages at IHR and MS were 48 and 54 years/respectively. This was statistically significant (P = 0.0000), so the results of the third RMEs, performed after the subjects' 46th birthdays, were also analysed. The findings were also reduced into quinquennia. Since the RMEs were weighted towards cardiovascular disorders, the outcomes of the 37 IHRs from arterial disease were sought and compared to the final results of those with MS. In both final and third RMEs, those completing MS were more likely to be non-smokers (60.9 vs 41.4%; 51.6 vs 42.6%; P = 0.01 and 0.015). In the final RME, subjects with MS generally had normal lung function (abnormal results 4.8 vs 10.4%; P = 0.002), abnormal chest X-rays and near vision (22.4 vs 7.6%; 91.1 vs 51.6%; P = 0.000 for both). In the third RME, firefighters with IHR were more likely to have hypertriglyceridaemia (39.6 vs 22.4%; P = 0.004), and reduced distance vision (32.2 vs 21.2%; P = 0.03). Where IHR resulted from arterial disease, sufferers had raised mean cholesterol (6.76 vs 6.20 mmol/l; P = 0.049), raised median triglycerides (2.1 vs 1.55 mmol/l; P = 0.0236), hypertriglyceridaemia (44.4 vs 21.2%; P = 0.008) and less likely to be non-smokers (32.4 vs 60.9%; P = 0.001). Differences between body mass index, systolic and diastolic blood pressure, fasting and HDL cholesterol, electrocardiogram abnormalities, urinary abnormalities and total numbers of risk factors did not reach statistical significance, apart from isolated quinquennial episodes. These results suggest that, except for highlighting known health hazards, current RMEs are ineffective in identifying those at risk of ill-health retirement in this group.     

Activity profiles of the occupational health services in a multinational company

The management of the European division of a multinational company was aware of possible differences in the occupational health services (OHS) at their different locations. The objective of this study was to carry out a baseline assessment of these OHS. Structured interviews with representatives of the OHS were conducted at 20 locations in 11 countries. The OHS Recommendation from the International Labour Organization (ILO) was used as a standard for the organization and functions of the OHS. Considerable differences in the activity profiles of the OHS were detected. The inter-enterprise, multidisciplinary OHS spent most of their time on surveillance of workers' health in relation to work and on preventive activities in the working environment. Little time was spent on curative services for individual workers. OHS made up of individual physicians and nurses generally spent much of their time on treatment of occupational and non-occupational diseases. This study has clarified the status of the OHS providers and the potential for improvements in order to meet the needs of the company's locations and to comply more closely with the ILO recommendation.     

Seafood processing in South Africa: a study of working practices, occupational health services and allergic health problems in the industry

The work practices, occupational health services and allergic health problems among workplaces which process seafood in Western Cape province of South Africa were examined. A cross-sectional study was conducted among 68 workplaces that were sent a self-administered postal survey questionnaire. Workplaces reporting a high prevalence of work-related symptoms associated with seafood exposure were also inspected. Forty-one (60%) workplaces responded to the questionnaire. The workforce consisted mainly of women (62%) and 31% were seasonal workers. Common seafoods processed were bony fish (76%) and rock lobster (34%). Major work processes involved freezing (71%), cutting (63%) and degutting (58%). Only 45% of workplaces provided an on-site occupational health service and 58% of workplaces conducted medical surveillance. Positive trends were observed between workplace size and activities such as occupational health service provision (P = 0.002), medical surveillance programmes (P = 0.055) and reporting work-related symptoms (P = 0.016). None of the workplaces had industrial hygiene surveillance programmes to evaluate the effects of exposure to seafood. Common work-related symptoms included skin rashes (78%), asthma (7%) and other non-specific allergies (15%). The annual prevalence of work-related skin symptoms reported per workplace was substantially higher for skin (0-100%) than for asthmatic (0-5%) symptoms. The relatively low prevalence of employer-reported asthmatic symptoms, when compared to epidemiological studies using direct investigator assessment of individual health status, suggests likely under-detection. This can be attributed to under-provision and under-development of occupational health surveillance programmes in workplaces with less than 200 workers. This is compounded further by the lack of specific statutory guidelines for the evaluation and control of bio-aerosols in South African workplaces.     

Occupational health in the USA in the 21st century

Comparable to the confusion encountered in the birth of the machine age is the perplexing reconfiguration of the United States' health care system. Paralleling the advances in medicine have been the divesting mergers and downsizing of industry, coupled with globalization, which have released millions of long-time workers. The labour contingent is changing, with the addition of great numbers of women and immigrant workers, and the manufacturing economy has become one of service and information. Serving the occupational health (OH) needs of such a force have been the professional societies of physicians, nurses, and industrial hygienists, with their members providing care in a broad variety of facilities. It is possible that a national organization, including all these disciplines, would have a greater voice in the protection of workers' health. Immediate leadership of an occupational health service (OHS) can be rotated among the disciplines, so that competition for primacy among the professionals would end. The new workforce demands culture sensitivity among OH personnel and polylingual capabilities may be demanded in the future. Management skills will be required of all in OH, and greater participation of employees in OH policy will characterize the decades ahead. Nearly neglected up to now, occupational mental health programming will be required to meet the real needs of workers, and to counter the move to outsource OH services, where little patient contact results. Behavioural safety, total quality management, and application of the rapidly developing technologies in health care will define the 21st century efforts in OH. Remaining issues, such as violence, telecommuting injuries, the inclusion of alternative medicine, and women's health, among others, will see carry-over for resolution into the year 2000.     

The interaction between general practitioners and occupational health professionals in relation to rehabilitation for work: a Delphi study

BACKGROUND: Anecdotally, communication between general practitioners (GPs) and occupational health professionals is poor and acts as a barrier to successful rehabilitation for work. It is not known how widely this view is held by the many stakeholders in rehabilitation for work, or how important the observation is in its effect. METHODS: A Delphi study was conducted by initial semi-structured telephone interview, followed by a three-round collation and feedback of opinion by e-mail. The 25 participants were identified by suggestion within the study process for their position as key informants within a wide range of stakeholders. RESULTS: The process generated a consensus statement which identifies the extremely important nature of rehabilitation for work, the crucial role by GPs, the central role of occupational health professionals in case management and the barrier represented by the often very poor communication between them. CONCLUSION: The way forward is to improve communication by mutual education and understanding and a team approach to rehabilitation strategy. This may be facilitated by the GPs who work in occupational health and disability assessment and the involvement of other health professionals to great benefit for all stakeholders.     

Occupational health in the Andalusian Fisheries Sector

BACKGROUND: The conditions of work in the fisheries sector are arduous with high rates of occupational accidents. Numerous factors are known that can directly influence the health of the sailor or fisherman both in fishing and merchant fleets. AIM: To evaluate the health status, safety and working conditions in the Andalusian fishing sector. METHODS: Cross-sectional questionnaire study with proportional sampling of the health and lifestyles of fishery workers in 19 of the 23 Andalusian ports. RESULTS: A total of 247 workers employed on 202 craft fishing boats responded. In all 87% of workers reported a current medical condition. The main problems reported were musculoskeletal disorders, respiratory diseases, diseases of the digestive system, eye problems and skin problems. A total of 72% reported taking some self-prescribed medication, and 60% of fishery workers smoked. Nine per cent of fishery workers admitted taking illicit drugs and 3% reported using illicit drugs on board. Diets on board were poorly balanced. While on board, 62% of crews reported a subjective significant worsening of previous health. The lifetime prevalence of accidents was 76%. CONCLUSIONS: Fishery workers had a high prevalence of self-reported medical problems, a high prevalence of self-medication, poor diets and frequently smoked. Self-medication and some medical conditions (diabetes, angina and depression) may reflect a potential failing of health checks and pre-employment checks. National health services and insurance companies dealing with occupational health should focus more on appropriate health checks, illness prevention and health promotion activities for this population.