Occupational Health Physician and Occupational Health Nurses

Historical Background

Occupational heath psychology is a very old phenomenon and the concern related to workers’ health and safety is not just a national issue; this issue has have been affecting the global economy. At both national and international levels, it is understood that employees’ protection at work place is the employers’ moral and legal responsibility (Erickson, 1996). Workers in developing countries face more health switch than the workers in the developed world do (Rosenstock et al, 2005). In 1848, Rudolf Virchow, a young physician, did the investigations of a coal mining population of Silesia. He criticized the government of the country for the drastic living and working conditions of the people working in the mining and fought for their rights and for reducing their working hours and to provide them with medical facilities. The awareness about workers’ safety and health at workplace started spreading everywhere. This upheaval was seen in Europe also (Abrams, 2001).

In the mid 19^th century, Friedrich Engels, through his book, ‘The Condition of the Working Class’ in England tried to find out the influence of workplace policies on its employees’ health. He described elaborately about the physical and psychosomatic health problems of the workers having all different employments and suggested that these problems instigated in the organization of the work and its social and physical atmosphere. In ‘Das Kapital’, Kal Marx wrote about the horrendous ways in which the employees were exploited at their workplaces. In Europe, many people became aware of health effects at work places and praised Marx and Engels for this intellectual contribution (Barling & Griffiths, n.d.).

In the mid 20^th century, the researchers from the Tavistock Institute of Human Relations in London revealed the negative effects of ignoring the workers’ psychological health (Trist & Bamforth, 1951 as cited in Barling & Griffiths, n.d.). Einar Thorsrud , the founder of ‘occupational health psychology’ in Norway and his colleague Emery, conducted pragmatic research on the empowering of work groups.

Occupational Safety and Health Services

Today’s world is having many industrialized countries where working population is increasing day by day. Workers have to perform more mental work than physical. It is estimated that approximately, half of the global population spend one third of time on working. The major social determinants of health are fair employment and decent work. In this new work life it is not sufficient to follow the traditional way of facing with risks at work place. Therefore it is very important to expand the idea of occupational health services globally, which should be ahead of the traditional risks and prevention approach.

Occupational Health relates to the work environment that an employee gets while performing his duties and the problems he may face. Occupational injuries could be due to avertable causes, which can be taken care of with the help of currently available methods (Alli, 2008). These problems could be loss of limbs, vision and hearing etc. they also include problems due to breathing, swallowing and other health related problems (Occupational Health, 2014).It is a medical specialty that observes the effect of people’s health on their work and vice versa (Occupational Health Assessment, n.d.). Occupational Health is provided by the employer or employee assistance programs to support staff through difficult times during ill health (Guidotti, 2011). It is a means to protect the workers from potential risk at work place and provide an environment that is congenial for their physical and psychological development (Kopias, 2001).

People involved in the field of occupational health and safety want the nations to keep occupational health and safety at a significant place in their political agendas. International Labor Office (ILO)and World Health Organization(WHO) have jointly been active in providing guidance and data base to countries regarding Occupational Health and Safety. In spite of that, there is a paucity of occupational health services for a huge number of workers (Proceedings, 2011).

Basically, Occupational health services do the assessment of the employee’s physical and mental appropriateness for work. Advice is taken from General Practitioner in case of disagreement. Advice to the employer does not contain the confidential medical details but advices on the types of adjustments that might be required to task, machines or the environment (Occupational Health, 2013). A Lot of the work of an occupational health service is proactive and aims at reducing potential workplace related problems.

The Major task done by Occupational Health Services includes:

• Prevent work related ill health
• Suggestions on preventing occupational injuries and disease
• Suggestion on work fitness and workplace safety.
• Advice on the required adjustments in the workplace to help employee stay in work.
• Assist the management in improving the attendance and performance of the workforce.
• Provide rehabilitation assistance to returning employees, and advice on suitable alternative to people with health issues.
• Recommend policies to maintain safe and healthy work environment.
• Ensure health and safety regulations compliance.
• Reducing and removing workplace related hazards.

(Occupational Medicine, 2014).

The Faculty of Occupational Medicine has set standards for an accreditation system for occupational health. This voluntary accreditation system is called Safe, Effective, and Quality occupational Health Service (SEQOHS), which works to these standards. These standards contain Business integrity, information control, people, facilities and equipment and relationships with purchasers and workers (Tips for Purchasing Occupational Health Services, n.d.).

Employee Assistance Programs, which is known as EAP, is generally offered by an employer to his employee. Generally, it is 24 hrs helpline that an employee can call for the support and any kind of advice. In short, EAP’s help both employee welfare and company performance.

In many countries the employees do not get the compensation of the cost of occupational health services. A few European countries, the occupational health services are sponsored either partly or fully by the accident insurance or by social insurances. In the countries like Sweden and Netherlands, the reimbursement system is to some extent only one of its kind. It is 50% of the costs of services to the employer. But in Finland the coverage for occupational health services is the highest in the world. It is 90% of the employees (Taskinen, 1997).

Occupational Health Professionals (Physicians & Nurses)

Business / Industrial Clinics start the Occupational medicines, which are staffed by a physician and nurse, who are trained in the care of patients in the business / industrial environment. These clinics are dedicated in the study, analysis and healing of illnesses that could be caused by the work environment (What Is Occupational Health? Mental health support at work, 2008).

These professionals work in occupational health role in controlling work related diseases and stress of the employees and provide specialist rehabilitation advice (What is an Occupational & Environmental Physician?, 2009). An employer can refer his employee to occupational health service if the employee is having a health problem, which is affecting his work performance or causing him to take sick leaves more than two to three weeks at once. An Employee can also refer himself directly to the Occupational Health Service. But it is advised to keep the manager /employer aware so that he/ they are able to provide suitable workplace support.

The suggestions given by occupational health professional are used to make adjustments at work to support the employees. The suggestions given to the employer are for them to act upon as they consider appropriate. They may not follow the advice but should justify the reason for not doing so (Occupational Health Service, 2013).

Occupational Health professionals have to face the continual ethical challenge of satisfying the requirements of the employer and meeting the expectations of the employee as a patient (Heikkinen et al, 2006). The role of the health professionals is to check the impact of work on an employee. They make sure that these professionals are in their good form for the work they do (Stellman, 1998). These experts are perfectly and exclusively positioned to support and help employees to stay in work and live healthy and full lives (Occupational Medicine, 2014).

Occupational Health Physicians

“An occupational physician is a doctor who possesses a qualification in occupational medicine recognised by the Faculty of Occupational Medicine and has particular competencies, acquired through postgraduate training and experience and who maintains these through ongoing continuing professional development, and annual appraisal that addresses his/her practice in occupational medicine” (The Occupational Physician, 2013, Para 1).

Occupational physicians dedicate themselves to study and treatment of various illnesses caused by industrial environment (Occupational Physician, 2014). Occupational health professionals are competent in dealing with health and injury related matters of the workers. These doctors combine their medicine knowledge with an understanding of the work related physical hazards that a person may face (The Occupational Health Physician, 2013). In order to identify the work related risks they work casually with the occupational professionals and administer the required treatment. Generally, occupational doctors carry out their practices independently.

These doctors devote majority of their time in analyzing the risks that the workers may face, such as, excessive noise, polluted air, dangerous machinery, number of working hours for an employee and its effect on the worker in terms of stress and tiredness. They meet with the workers regularly to monitor changes in the worker’s health condition and guide on the best ways to prevent illness and injury (What do occupational health doctors do?, 2014).

An occupational health physician does the assessment of the workers of any organization by doing their medical examination. It is to recommend some adjustments for the workers to work in a safe and healthy environment (What is an Occupational Health Assessment? 2010).

Occupational Health Nurses

According to the Canadian Occupational Health Nurses Association an Occupational Health Nurse is:

“… a registered nurse practicing in the specialty of Occupational Health & Safety to deliver integrated occupational health and safety services to individual workers and worker populations. Occupational Health Nursing encompasses the promotion, maintenance and restoration of health, and the prevention of illness and injury” (COHNA, 2000, as cited in What is occupational Health Nursing, n.d., Para 3).

Occupational health services involve the group of people who work as a team. This team is engrossed with the people like, physicians, physician assistants, nurses and nurse practitioners (Rom & Markowitz, 2007). There are many factors involved, which have affected the progress of occupational health nursing practice like changing workforce and population, increased work demand and focus on injuries and illness etc. (Rogers & Ostendorf, 2001). The occupational Health Nurses work in a variety of settings as independent practitioners or as part of occupational Health service team. These teams are generally attached to HR or personnel department (Occupational Health Nursing, n.d.).They provide advice to employers to prevent or reduce work related health problems (Human Resources: Occupational Health Service, 2005).

They provide legal health surveillance, advice on fitness for work and rehabilitation. They also provide guidance on statutory compliance in relation to health and safety and Disability Discrimination Act.

Occupational Health Nurses have a valid license for doing their job, which is to observe and evaluate workers’ health. Applying their skills and experiences, they first identify the health effects caused by perilous contact and then try to prevent those effects and treat the workers injuries caused by those ill effects (Occupational health nurse, 2014). In Britain, The main health care service providers, is the NHS and its staff of approximately more than 1.4 million. It is essential they should be provided with adequate support and care. IOSH supports the execution of the Boorman recommendations for facilitating the performance of NHS staff (Healthy Lives, Healthy People, 2011).

These nurses are the educators, consultants, clinicians and case managers. These nurses: (Nursing in occupational health, n.d.).

• Possess special knowledge of workplace risks
• Know about industrial hygiene principles and administrative controls
• Have the knowledge of epidemiology which is related to the employee and the work site

Their responsibilities are (Roles and responsibilities of occupational health support workers, 2011):

• Gatekeeper for healthcare services
• Environment health
• Emergency preparedness
• Rehabilitation
• Emergency care for job-related injuries and illness
• Disease management

The Health and Safety Commission and Executives

Health and Safety Commission emerged in 1974 and appointed Health and Safety Executives in 1975. The main function of HSC is to protect health and safety of employees and it is achieved with the help of HSE. It provides strategic direction to Great Britain’s health and safety system (Moving Forward, 2008). HSC is responsible for observing whether the regulations are in place and the employers are following the regulations made by HSC (Rooney et al, 2008).

Occupational Services in European Countries

Many countries have come across the problem of violence at work in the past years, consequently, witnessing an alarming situation for the safety and health of workers. In Scotland, a new amendment was done in the legislation regarding the occupational hazard. The Scottish Parliament Justice Committee approved the ‘The Emergency Workers Act ‘in view of the increasing problem of violence at work places. This Act would ensure that the NHS staff and other professionals like the GPs, other doctors, nurses and midwives are protected against any violence (Enhanced Protection of NHS Workers, 2008).

A comprehensive study of the OHS in 17 European countries suggested that in countries like France, Luxembourg, Belgium, The Netherlands and Finland, the OHS covers seventy five to hundred percent of the employees. Countries that cover thirty five to sixty percent of the employees are Norway, Austria, Portugal, Denmark and Sweden. Countries showing least coverage are Italy, United Kingdom, Switzerland, Spain and Ireland (Elgstrand, n.d.).

Bigaignon et al conducted a survey to identify the role of occupational health nurses and to do the comparison of their activities with other countries. This survey covered almost the whole Europe. The survey revealed that in most of the countries, the internal commercial services take care of the healthcare for healthcare workers with the exception of the countries like Germany and Belgium. In these countries, external structures take care of such things.

It was concluded in this survey that many countries were lacking the presence and training of occupational health nurses. Most of the countries even did not have any data of their occupational health nurses except a few countries like, Norway, Finland and Luxembourg (Bigagnon et al, 2005).

OHS services in Europe do not have similar standards. As per the trade unions view, these do not fulfil the expectation and there is reluctance towards OHS professional autonomy (Walter & Westerholm, n.d.). The Greatest challenge in maintaining the same standards is difficult in of the view of the different types of occupational hazards occurring in different countries (Zimmer and Hoffer , 2009).

However, in Germany, the OHS services are followed in agreement with the international law. The relevant EU legislations along with the German legislation also form the basis for it. The big companies have in-house health professionals whereas the smaller ones hire these services on contract basis. The main law covering the OHS in Germany is the Occupational Health and Safety Act that is a direct transposition of E C Directive.

There were 319 697 physicians in the year 2008 in Germany. Out of these, 55.7% were general practitioners and 45.3% were specialists. However, not even 1% were fully trained occupational physicians and only 3.7% had acquired proper training in occupational medicine. The occupational physicians, normally, do not work under the public health care system in Germany; however, they are free to assume private practice.

In Germany, the employer and the employee both contribute, more or less,in the insurance schemes for the social security system. However, every employer is bound to fund the statutory accident insurance, solely, in favour of the employees. There is no requirement of a official employment contract for eligibility for the compensation. The statutory accident insurance scheme covers the compensation for seek leaves retirement due to occupational disease (Country Profile of Occupational Health System in Germany, 2012).

Legislation of Finland and Netherlands compels employers to offer their workers Occupational health services. “The ratio of occupational physicians and occupational health nurses to workers in Europe vary between 1 per 500 and 1 per 5000” (Nicholson, 2004, p. 148).

Roughly 14 % of the workers in the UK get advantage of Occupational health services. SMEs having 250 employees made this known that 14.4% of them had a part time physician, 7.2% had health and safety advisor and 10.8% SMEs had a part time occupational health nurse (Nicholson, 2004).

Number of physicians working in Occupational health service by country- in Finland 1400 and no of physicians per 100, 000 workers were 61, Netherlands 1900 no. of Physicians and per 100,000 workers there were 26 physicians. In Norway no. of physicians were 500 and per 100,000 workers physicians were 21 and in the UK no of physicians were 1400 and per 100,000 workers were 5 (Nicholson, 2004).

The increasing number of the immigrants in the workforce has created a different ethnic mix chiefly in the occupations that belong to the low-paying category. The creation of this culturally diverse workforce poses many challenges for the occupational health professionals. These occupations include agriculture, construction, day laborers and sweatshops that are known for their long working hours, low pay and unsafe or unhealthy working conditions. Hence, there is a need to implement measures like supervision and research, right to use better health care, culturally knowledgeable care provider, advocacy and improvements in the immigration and health policy (McCauley, 2005).

The duty of employers for occupational services and professionals

According to the European Agency for Safety and Health at Work (EU-OSHA), it is obligatory for all employers to arrange for the safety and health of their workers at the workplace. The agency focuses on the procedures that contribute in improving the safety, health and productivity at workplaces in Europe. The agency endorses health and safety management at work places in Europe (European Agency for Safety and Health at Work, n.d.).

It suggests that employers should plan their strategies relative to the safety and health of the workers and employees carefully. They should fulfill all the requirements that lead to an appropriate risk assessment and suggest ways to handle it (Employers’ Roles and Responsibilities, n.d.). There are some liabilities on the employers to ensure, to their reasonable capacity, the safety and health of their employees and to ascertain their wellbeing (UNISON, 2014). The employers are liable to perform their duties with respect to the well-being of their workers:

1. Provide safe and risk free workplace: The employers are responsible for health and safety of the people working in their enterprises. They are expected to adopt appropriate measures to keep their workplaces safe for the safety and welfare of the employees (Employer’s Responsibilities, n. d.).
2. Protection of workers from possible hazards:
   • Employers are responsible for the protection of their workers from any hazard at the workplace and attempt to control the situations posing potential risk to the workers.
3. Risk assessment: Risk assessment by the employees at the workplace is mandatory under the health and safety laws. The employer must have knowledge about the potential risks in his business. He or she should be honest and transparent to his employees regarding these risks.
4. Training for potential risk and its prevention: It is the employer’s duty to make the workers aware of the potential risk at the workplace and provide training to the employees and workers for dealing with such situations (Employer’s Responsibilities, n.d.). The training and instructions should be illustrated in a lucid manner. In the workplaces where hazardous chemicals are used, the employer must emphasize on the written communication programme including the potential dangers and appropriate precautions with respect to certain hazardous situations (Employer Responsibilities, n.d.).
5. Employees participation in policymaking: Employers should encourage active participation of the employees and workers in issues related to health and safety at the workplace. The workers can participate directly or through their representatives (Employer’s Responsibilities, n.d.).
6. Use of appropriate signs and symbols at work place: Use of colour codes, labels and signs and posters to warn workers of the potential hazards.
7. Provision of safe equipments: Employers must ensure the safety of the equipments used at the workplace. These should be checked and maintained regularly (Employer’s Responsibilities, n.d.).
   • The employers need to make appropriate arrangements for the usages of articles and material at the work site. Further, the employer should appropriately manage the storage and transportation of these substances (Stranks, 2010).
8. Regular amendments in the required areas: The employers need to institute the working procedures accurately and arrange for their regular amendment as per the requirements. These updates should be communicated to the workers appropriately (Employer’s Responsibilities, n.d.).

Code of Ethics in occupational safety and health

In the past 10 years, several countries have exhibited interest in maintaining ethics in occupational health. Distinct codes of ethics have become a significant part of the occupational health profession.

There are many reasons that have led to the adoption of separate Code of ethics by different countries of the world.

• The professionals in the field of occupational health and safety have to face multifarious and challenging responsibilities related to health and safety issues of workers and employers. The public and the expert authority can raise questions to them. Moreover, they are answerable to the other bodies like public health and labor authorities and judicial authorities. The complexity and competition involved in the occupation demands specific Codes of ethics.
• The establishment of compulsory and voluntary occupational health services has increased the number of occupational health and safety professionals and thus require specific Codes of ethics other then the Codes of ethics for medical practitioners
• The involvement of various specialists from different professions due to multi-disciplinary and inter-sectoral approach in occupational health and safety has made it necessary to include distinct Codes of ethics in this field. (International Code of Ethics for Occupational Health Professionals, n.d.).

Duties/ authorities of the occupational health physicians and nurses

For an effective occupational health nursing practice, it is important to have sufficient knowledge and skill in environmental health sciences. The nurses should be aware of the principles of business and management and should have an in depth information of the regulatory processes. The occupational nurses can demonstrate their efficiency and knowledge through their certifications in the occupational health services. The evaluation of these certifications includes a job analysis through an organized process that includes description of the various duties and tasks, obligations, distinctive traits of workers and distinct working conditions. The job analyses are an integral part of the occupational health nursing practice as they ensure the legitimacy of the certification examination (Salazar et al, 2002).

The best predictors of the physical activity of the employees are demonstrated by the belief in their personal ability to perform self-efficacy in health behavior. Occupational nurses can motivate the employees in their discernment of self-efficacy through self-care classes and intervention programmes (Kaewthummanukul & Brown, 2006).

They perform the role of a clinician and health educator. In certain situations, they act as managers whereas in others they perform the duty as consultants. However, they need to perform all their duties efficiently and with full dedication in order to achieve the aim of their profession (McKay, n. d.).

The statutory regulations determine the duties and obligations of the employers and professionals with respect to occupational health and safety in his or her employment. These arrangements should comply with the health and safety requirements of the profession. In view of the diverse and multidisciplinary professional approach to occupational health and safety, it is mandatory to form some common principles of ethics. These ethics maintain a balance between the different conflicting rights in employment including the right to employment, individual rights and right to the protection of health etc.

1. Counsel the employers and workers: The occupational health practice is focused at maintaining a healthy and safe working environment. To achieve this goal, they need to pay attention towards using the risk evaluation methods. They should also propose efficient preventive means in this connection. These professionals must be able to provide necessary advice to the employers regarding their responsibilities towards the health and safety in the workplace. They should also counsel workers regarding the importance of their health and its protection with respect to work.
2. Sufficient knowledge regarding the issues related to safety and health: The physicians and nurses should keep themselves updated with the scientific and technical information related to the work and the working environment. Keeping sufficient knowledge about the occupational risks and measures to deal with them is also the responsibility of the occupational professionals (International Code of Ethics for Occupational Health Professionals, n. d.).
3. Establishing occupational safety and health policy: The efficiency of the health physician lies in the manner he handles the occupational health information. It is, therefore, important that all staff including the CEO and the newly recruited employee or worker, should have the knowledge about the policies and procedures related to occupational safety and health in written. In this way, there will be least possibility of any conflict and confusion related to OSH issues (CHAPTER 30: Ethics in Occupational Medicine, n. d.).

The occupational safety and health professionals have the responsibility to keep an account of the factors posing risk on the health and safety of the workers. They should make the executives aware of these risks immediately. Further, they need to establish an occupational safety and health policy to prevent such situations. These policies should be based on adequate and up to date scientific and technical information and the requirements of the working environment. A programme of prevention should be developed in agreement with the undertaking including ways of controlling occupational safety and health threats and examining them and moderating their impact in case of some calamity.

4. Applying simple and cost effective measures: The occupational safety and health professionals should apply convenient and rapid preventive measures in cases of proposed risks. These measures should be less expensive and technically advanced. Their implementation should avoid complicated procedures. The occupational professionals need to examine the validity and efficiency of these measures regularly and recommend improvement if required.
5. Recalling employers’ obligation towards health protection standards: It is the duty of the health professionals to bring into notice any negligence regarding the implementation of the appropriate steps immediately to the senior management executives. Thereby, recalling the duties of the employer for the protection and health of the workers within the framework of laws and regulations. Besides this, it is important that the workers that may get affected should be informed in this regard.
6. Providing sufficient information regarding the possible hazards: The occupational health personnel should inform the workers about the possible hazards in an objective and practical way. They should also be informed about the precautionary actions. It is also their responsibility to facilitate employers ‘efforts in providing adequate training and information in this regard.
7. Loyalty towards the organizations: Occupational health professionals are expected to keep the commercial secrets of the organizations they are working with. However, in case of any information that is affecting the safety and health of the workers, they need to inform the concerned authorities responsible for the implementation of the applicable legislation.
8. Elucidation of the surveillance: The health professional should clear the examination process to the workers. These observations should be carried out with the consent of the workers besides taking approval from the proficient authority.
9. Establish the criterion of fitness: The occupational health professionals have to set fitness standards for the workers for the particular work environments. These criteria should keep under consideration the workers health conditions and the demands of the job.
10. Reveal only necessary information regarding workers health to the management: The health professionals should reveal only that information regarding the health and fitness of the workers to the management that is necessary as per the national laws and regulations. General information regarding the possible health hazards relative to work should be revealed to the management only after the workers’ consent.
11. Protect workers against unsafe situations: Workers should be made aware of the situations where the health condition of a worker can cause risk to others’ health and safety. Further, support from the management or the competent authority can be sought in case of particularly hazardous situations.
12. Using trustworthy tests: The occupational health professionals should prefer only those investigations that are significant with respect to the work. Invasive examinations with potential risks should be evaluated on the basis of the pros and cons involved. These examinations should be carried out as per the greatest health standards.
13. Contribution to the community health: The occupational health professionals can create relevant promotional and screening programs and encourage the contribution of the employers and workers both in them.
14. Community and environment protection: The occupational health professionals should also identify the health hazards that may arise due to the operations and processes taking place in the enterprises. It is their duty to assess the potential risks and advise for their prevention in view of the safety of the community and the environment.
15. Scientific approach: The occupational health professional are required to inform the scientific community regarding the possibilities of any new occupational health risks and their possible preventive measures. The professionals should exercise full autonomy while being occupied in research. They should accomplish their work with dedication by applying scientific knowledge in scheming and operating their activities. The professionals should adhere to the ethical values relative to the research under the supervision of an independent committee on ethics (International Code of Ethics for Occupational Health Professionals, n. d.).

Law for occupational health and safety

Globalization has affected the world economies drastically and subsequently the world of work and workers. It calls for improvement in the occupational safety and health in all respects. The developments in the transport and communication, changing models of employment in general and with respect to men and women are taking place. Further, changing organization performances and constitution and life cycle of the organizations has led to the emergence of new risks in the world of work (Alli, 2008.).

There is an unavoidable link that persists between hazards at work places and safety and health of workers that demand implementation of legal standards for workers and the occupational health professionals too (Loewenson, 2001).

The EU set an advisory committee in 1974 embracing the issues of hygiene, safety and health protection at work. This committee consisted of six representatives from each member state. In 1978, the European Health and Safety Directorate was established.In 1984, the second action program started in this respect. The Single European Act, 1987 declared that the directives are required to be incorporated into national laws after being approved by the qualified majority in the Council of Ministers. In1989, the Framework Directive addressed the following issues related to occupational safety and health:

• assess risks and arrange for prevention
• appoint skilled health and safety professional
• arrange fire prevention measures , first aid and emergency management
• notify accidents and diseases and keep health report
• make workers aware of the potential health risks
• create health and safety measures in association with the workers or representatives
• provide health training
• ascertain the health surveillance is up to the requirement (MacDonald et al, 1999).

European Union (EU) influence

The European Union is a big and recognized market. It has to deal with the increasing knowledge based economy that has caused many changes in the workplaces. Short-term and non-standard working times are prevalent. Besides, feminization at work places and increase in the number of old age population has also generated a demand for more intervention in the field of occupational safety and health.OSH comes under the control of the EU, whereas other areas of the healthcare policy are under the control of the member states (OSHA Law and Regulations, n.d.). The Occupational Health and Safety at Work Agency (EU-OSHA), established in 1996, works in a “tri-partite arrangement with governments, employers, worker representatives. It commissions, collects and publishes new scientific research, makes information available and identifies new occupational health risks” (Lethbridge, 2008, p.13.).

The EU-OSHA, through its Europe-wide establishment survey on new and emerging risks (ESENER) of 27 member states of the European Union, Switzerland, Norway, Croatia and Turkey, found that the professional services related to psychosocial risks, like occupation related stress, harassment and bullying are not incorporated in the structural and formal procedures of the enterprises. The external information and support in this regard is normally on ad hoc basis. In connection with the implementation of good practices, greater support is required for the implementation of their procedures. Hence, there is a need for a more continuous support for all enterprises for occupational health and safety related psychosocial services (Vainio & Lehtinen, 2011).

The International Health Organization (ILO) provides recommendations for the occupational national safety and health (OSH) policies, however, the members need to approve this guidance before their implementation comes into effect. The national governments are expected to implement these standards or use them as a consultative facility, however, there implementation depends exclusively on the political wish of the respective nations. ILO works in association with The World Health Organization on issues embracing the occupational safety and health (Lethbridge, 2008).

A declaration was made by the Ministers in London while attending the Third ministerial conference on Environment and Health, which was organized by the WHO regional office for Europe in 1999:

“We recognize the importance of instituting workplace measures to meet public health needs and goals, and the right of workers to be involved in the decision-making process on those measures. We will promote good practice in health, environment and safety management in enterprises, in collaboration with stakeholders in our countries such as local authorities, enforcement agencies, business (including small and medium enterprises), trade unions, NGOs, social and private insurance institutions, educational and research institutions, auditing bodies and providers of prevention services…”(Whitaker & Baranski, 2001, p. 6).

WHO issued an international policy from its European Office ‘Declaration on Workers Health in 2006 and further published Workers’ Health: global plan of action’ in 2007 (Workers’ Health: Global Plan of Action, 2007).

According to WHO Global Plan of Action, the plan aims at:

“Devising and implementing policy instruments on workers’ health

Protecting and promoting health at the workplace

Improving the performance of and access to occupational health services

Incorporating the health of workers into other non-health policies” (Vainio & Lehtinen, 2011, p.13).

Administration of the Regulation

Several issues affect the implementation of the OSH policies at national level. The distribution of the duties between the Ministry of Health and the Ministry of Labour poses major difficulties in the implementation of these policies. These conflicts lead to the development of new policies that may not stick to the issues related to OSH while covering the occupational health concerns. Traditionally, the Labour Departments have been responsible for dealing with the issues related occupational health and the Department of Health looks after the health policies that embrace public health in general. These two approaches are now being amalgamated to develop wider health policies focusing on health at work (Lethbridge, 2008).

The Minister for Health and Safety looks into the matters associated with the HSC and HSE on behalf of the Secretary of State for the Department of Work and Pensions who controls the administration of these two bodies. He is also responsible for the actions, policies, and decisions of these two bodies before the Parliament. The Commission has the power to make criminal laws in effect ,as the Parliament does not involve in the discussion regarding its regulatory proposals. The Parliament members are authorised to question proposals in the committee, however, EU has been more active in this realm in past 20 years. The HSC has the right to approve the regulations presented by the HSE, before laying them before the Secretary of State and who, subsequently, presents them before the Parliament (Rooney et al, 2008).

The health and safety regulations in the UK are laid down primarily by the European jurisdiction. The legislations related to European Communities’ (EC) health and safety need to be reviewed appropriately. The area was poorly addressed since the opening of the single European Act in 1986 and until its completion by 1994. The inadequate interpretation and lack of transparency has affected the EC level health and safety calling for an improvement in the regulation of occupational safety and health. The German 2007 EU Presidency proposed commitment towards an improved health and safety regulations was followed by a systematic evaluation of the directives related to their appropriateness in occupational health and safety. The UK is a founder member of the ILO since 1919.

The process through which the standards of the European Directive are selected and put into Great Britain’s law is called the transposition that characterizes the implementation of regulations. The EC Official Journal issues the directive with a deadline of three years. The HSE prepares a Consultation Document having the draft regulations and publishes it in the HSE consultation directory. This draft is available at the HSC/E website also. This procedure calls for a discussion on the draft and their analysis. The proposed amendments are taken care of and the HSC recommends the amended Regulations to the Ministers of the U.K. who in turn approve the regulations and lay them before the Parliament and bring into operation. It is the responsibility of the U.K. government to ensure that the new or existing legislation meet the standards of the European Directive. The European Commission makes it sure that the implementation report is presented by the Member States after the deadline has approached (Rooney et al, 2008).

In the U.K., the shape of the OSH requires to be changed with the needs of the business world. Hence, there is an urgency to change the old and adopt the new measures to meet the challenges in terms of improving the health of the workers. Simply reorganizing the deck without changing the game is a political stunt that would bring about no satisfactory results (Nicholson, 2004).

“HSC reported that 2.2 million people in 2006/07 were suffering from an illness they believed was caused or made worse by their current or past work” (House of Commons-Works and pensions committee, 2008, p.10).

The Legal frame work for Health and Safety in the UK

Regulations are laws that have gone through the process of ratification in the Parliament. These regulations are proposed by HSC and subsequently formed chiefly under the Health and Safety at Work Act (Health and Safety Legislation, n.d.). The EC Directives based regulations and the domestic regulations both have to go through this process (Health and Safety Regulation, 2003).

“There are two basic health care torts (1) negligence, which involves the unintentional act or omission of act that could negatively contribute to the health of a patient, and (2) intentional torts, such as assault and battery and invasion of privacy” (Buchbinder &Shanks, 2007 as cited in Legal, Ethical, and Safety Issues in Healthcare Workplace, n.d., p.34).

Two sub divisions of the law, the criminal law and the civil law, are associated with the health and safety related matters.

Criminal Law

Criminal law protects the people from offense by the people. In the occupational health and safety related issues, HSE or Local Authority Environmental Health Officers enforce the criminal law under the Health and Safety at Work (HSW) etc. Act. A person who violates criminal law is subject to the prosecution in the court and liable to punishment if found guilty. In such cases, the Criminal Court requires a proof that is ‘beyond reasonable doubt’. However, in criminal cases that involve health and safety, the HSW Act 1974 requires duty to do something ‘so far as is reasonably practicable’, thereby proving the accused that there was no other option than to release his duties under the Act.

Civil Law

Civil law intends to resolve the disputes between people or individuals and enterprises. The major concern is to find the degree of liability and not guilt. The penalty is laid by the Civil Court in the form of compensation to the claimant. The Health and Safety related issues that come under civil law include accidents, carelessness, sickness or a violation of the statutory duty. Normally the disputes are resolved out of court (Hughes & Ferrett, 2011).

The Parliament in the UK has assigned the professional bodies to regulate law in different sectors. Some examples of these bodies are “General Medical Council (GMC) for doctors (Medical Act 1983), and the Nursing and Midwifery Council (NMC) and for nurses, midwives and health visitors (Nurses, Midwives and Health Visitors Act 1997)” (Kloss, 2010, p.124).

Council for the Regulations for Health Care Professionals (CRHCP)

The committees set by these bodies determine the suitability of the professionals for their respective jobs. However, in recent years unsatisfactory performance of the professional bodies in regulating the law adequately led to the creation of a Council for the Regulation of Health-care Professions (CRHCP) that is now known as the Council for Healthcare Regulatory Excellence. This Council was established under the National Health Service Reform and Healthcare Professions Act 2002. With this Act, the Council had the power to ask the High Court to review those decisions that showed some leniency. The guidance for the medical professions is published in the Good Medical Practice published by GMC and is reviewed regularly, whereas, The Nursing and Midwifery Council follows the Code of Professional Conduct released in 2008 (Kloss, 2010).

In case of incompetency of the Occupational Health professionals, they can be prosecuted and convicted under the prescribed law.In U.K., if an employer has to bear the responsibility of an offense caused by the act of an Occupational Health professional, the guilty nurse or doctor is subject to prosecution and conviction under section 36 of the HSWA (Kloss, 2010).

In Great Britain, health and safety is controlled by two agencies. One is the Health and Safety Commission (HSC) and the other is Health and Safety Executive (HSE). The proposed merger of these two bodies opens new avenues for the development in the health and safety sector in Great Britain (House of Commons-Work and Pensions Committee, 2008).

Major Health and Safety Acts in UK

A number of principal Acts in association with several subordinate Regulations and Orders compile together to make the UK health and safety legislation.

Health and safety legislations in the UK have evolved in stages showing no consistency and not embracing all areas. Pre-1974 legislation in health and safety affected the specific group of people based on their working sites. A specific inspectorate for different premises regulated the main Act. The inspectors were authorized to impose fine on the organization in case of any violation of the regulation. The employer was mainly responsible for the proper implementation of the legislation

Here is an overview of the main Acts that relate to the health and safety at work. These Acts excluded a large segment of population working in the workshops and third party people like contractors, roads sweepers or visitors in their draft. Hence, a committee under the leadership of Lord Robens looked into the matter deeply and made many recommendations. Central recommendations of the Robens Committee were incorporated in the Health and Safety etc. Act 1974 with the approval of the Parliament (Ridley and Channing, 2003).

Health and Safety at Work etc Act 1974

The present health and safety system of Great Britain is based on the Health and Safety at Work etc. Act 1974. This the main piece of legislation that embraces all safety and health related issues at work environment (Employers’ health and safety responsibilities, 2014).

The legislation is supported by the belief that the responsible persons for the potential risks at the workplaces should be liable to prevent them. HSC identifies the new confrontations that arise due to the fast changes in the world and attempts to deal with them (United Kingdom Focal Point of the European Agency for Safety and Health at Work, n.d.).

It is also known as the HSW Act, the 1974 Act, HASAWA or HSWA A ct. The Health and Safety Executive is accountable for the enforcement of this Act. It can take assistance of the local authorities in doing so. It is responsible for the enforcement of several other Statutory instruments with respect to the safe working environment (Health and Safety at Work etc Act 1974, n.d).

“Health and Safety at Work etc Act 1974, permits statutes, regulations, orders and other instruments to be progressively replaced by a system of regulations and approved codes of practice operating in combination with the other provisions” (Rooney et al, 2008,p.155).

Besides other provisions the Act directed that

• the operation and maintenance of the workplace or enterprise should not pose any harm to the workers and others
• the entrance and exit areas should be regularly protected
• handling and storage of the hazardous articles should be done with appropriate care
• the staff should be provided sufficient training with respect to ensure safety and health at work site
• there should be provision for appropriate welfare programmes for the workers

Besides the above-mentioned provisions, the employers must create a written policy, with the proper consultation of the employees or their representatives, regarding health and safety at their enterprise (Health and Safety Legislation, 2013).

The first Director General of HSC, John Locke believed that the Act was “a bold and far-reaching piece of legislation” (The History of HSE, n.d. Para 8).

This Act was an example of a non- authoritarian and objective regulation that gave the employers and employees an opportunity to participate in the planning of the health and safety system for the first time. The two regulatory bodies HSC and later the HSE were constituted for the proper enforcement of the health and safety law (The History of HSE, n.d.Para 8).The Act issues general responsibilities of the employers and employees. It also notifies the duties of the public in safety and health related issues (Tar-Ching, 2001).

Recent Regulations in Occupational Health and Safety

The Health and Safety at Work etc Act 1974 is the primary foundation for the health and safety law in Great Britain. Moreover, the following regulations are applicable usually across all the workplaces:

Management of Health and Safety at Work Regulations 1999

This regulation directs the employer to analyze the risks at work place and take preventive measures for his employees accordingly. It also necessitates the appointment of competent people and provides adequate knowledge and training (Barrett & Howells, 2000).

Workplace (Health, Safety and Welfare) Regulations 1992

This regulation includes vital issues related to health and safety. Matters like ventilation, lighting, seating workplaces etc. are covered under this regulation (Health and Safety, 2013).

Health and Safety (Display Screen Equipment) Regulation 1992

The regulation is aimed at preventing the health and safety risks that occur due to the use of display screen equipment.

It necessitates assessment of the workplace and the daily schedule of the users. The employer is responsible for providing appropriate training, eyesight testing and curative spectacles to the users (Display Screen Equipment Regulations, 1992).

Personal Protective Equipment at Work Regulations, 1992

This regulation requires that the employer should provide adequate personal protective equipments (PPE) to the workers to deal with the potential risk at work (Personal Protective Equipment at Work, 2005).

Reporting of injuries, Diseases and Dangerous Occurrences Regulation Act 2013 (RIDDOR)

This law is enforced on the employers and other people working in the premises, to notify and keep records of work related deaths, serious injuries and diagnosed cases of industrial diseases and certain dangerous occurrences such as near miss accidents and certain gas incidents (RIDDOR- Reporting of injuries, Diseases and Dangerous Occurrences Regulation Act 2013, 2013.).

Conclusion

An unavoidable link persists between hazards at work places and safety and health of workers that demands implementation of legal standards for workers and the occupational health professionals too. The International Health Organization (ILO) provides recommendations for the occupational national safety and health (OSH) policies. The national governments are expected to implement these standards or use them as a consultative facility, however, there implementation depends exclusively on the political wish of the respective nations. The occupational safety and health professionals have the responsibility to keep an account of the factors that may cause risk to the health and safety of the workers. Their policies should be based on adequate and up to date scientific and technical information and the requirements of the working environment. In the U.K., and many other European countries, the shape of the OSH requires amendments to meet the requirements of the modern business world. Hence, there is an urgency to change the old measures and adopt the new ones for improving the health of the workers.

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