Comments are closed. LondonUnderground’s occupational health service has evolved from a back room in theHR department to a fully-fledged department offering a range of services to more than 23,000 members ofstaff, by Nic PatonBackin the 1950s, it has been alleged, a London Transport bus driver had a heartattack and ploughed into a queue of passengers at Oxford Circus, killing andinjuring many. That is how, so the story goes, what is now London Underground’sOH service began.”It’s an apocryphal tale, I think, because I havenever, ever found any evidence for it,” laughs Dr Olivia Carlton, head ofOH at London Underground (LU).Whatis beyond doubt, however, is the modern-day commitment to OH. The transportnetwork spends around £2m a year on OH, employing a 50-strong service toprovide for the health needs of some 23,000-25,000 people. Indeed,when you walk into LU’s OH department near Edgware Road, it is much likeentering a GP surgery, with a spacious waiting room, appointments’ desk andconsultation rooms, as well as the obligatory pot plants and vending machines.And that’s just one floor.Carltonhas been with LU since the late 1980s, becoming head of the service in 1994 andtransforming it from a medical outfit located within HR to a much moresubstantial operation within LU’s safety directorate.Itsnew home has been very much part and parcel of pushing OH firmly up the agenda,she says. “Both safety and HR have a very big impact on the way LU is run,for obvious reasons. There is no question that since moving into the safetydirectorate two years ago, our influence has increased. Some of that is alsoreflecting the health and safety agenda being run by the Government,” sheexplains.Aswell as treating around 11,500 station, train, control room and managementstaff, the OH team has responsibility for the health and well-being ofemployees working at Transport for London, the London river buses, the peoplewho license and test black cabs and London Bus Services, which manages thecontracting-out of the capital’s bus routes. OH services are also stillprovided to some 6,000 engineering staff, even though their operation hasrecently been sold to the private sector under the Government’s public-privatepartnership scheme.TheOH department consists of a medical advisory service, counselling and traumaservice, a drug and alcohol service and access to occupational hygiene.Medicaladvisory serviceThemedical advisory service, explains Carlton, has two main areas of operation:safety, and what she describes as “productive working time”.Safetyin this context, as might be expected, is about assessing whether an employeeis fit to do their job. “To protect other employees and the travellingpublic, should we let a train operator carry on being a train operator if, forexample, they had a fit last week?” she explains.Activitiesinclude routine and non-routine medical assessments, pre-employment medicals,reviews with managers of sickness absence, and procedures such as hearing,mobility and vision checks. People with heart conditions will, for instance,have a routine ECG test.”Dowe discriminate? Yes we do, undoubtedly, because we discriminate againstdisability. But what we believe the Disability Discrimination Act says is thatyou must not discriminate without good reason. A lot of our work is trying toreview whether or not we have good reason,” says Carlton.Whenit comes to productive working time, the emphasis is much more on attendance,achieved by a case management approach. LU sets targets for absence levels,currently between 95 and 96 per cent for operational staff, and 98 per cent fornon-operational. Overall, absence rates are running slightly below target, withsome groups up to or above 98 per cent, and others well down at 90 per cent.LUis studying why there might be such differentials, but it’s often down to linemanagers, believes Carlton. “It is not always about the busy sessions, butabout how much you enjoy coming to work. Are you properly supported when youare at work, is it a pleasant place to be or do you dread it when you wake upin the morning? Because that can make the difference of whether you come in ornot when you are feeling ill.” Themain medical issues the OH team deals with are stress, anxiety, depression andmusculoskeletal disorders, particularly bad backs, she adds. Aftera member of staff has been off work for a certain period of time, their case isdiscussed by a member of the OH team, along with the employee relations managerand a line manager. Individual managers will feed in to a team leader who willthen discuss a range of cases. From there, an action plan is agreed.Twoyears ago, a physiotherapy service was introduced for employees with acute backpain. After an assessment, employees are given the options of hands-ontreatment, an exercise class or both. Bookings can be made directly by theemployee through their manager. The hope is that eventually this service willbe extended to necks, shoulders and upper limbs.Counsellingand traumaLocatedwithin the OH department, the counselling and trauma team employs around 16people and splits into two elements, generic counselling and traumacounselling.Thegeneric counselling service is based on a six-session format. The first elementof the service is a structured telephone interview with a counsellor. Between20 and 30 per cent of those who call will proceed with this method ascounselling is not seen as offering the most appropriate way forward. Overallusage of the service is between 5 and 10 per cent of employees.”Ifwe can support people through difficulties, we can increase their performanceat work. It may sound grim, but it’s a win- win situation. We have a powerfulbelief that everybody goes through times in their lives when things get really,really tough,” says Carlton.Solutionsreached might be as simple as relaxation techniques or looking at how employeesrelate to people. If after this employees need further help, OH directs them toexternal agencies, which LU will pay for.Thetrauma operational staff may be exposed to comes from two main areas: somebodytrying to kill themselves by jumping in front of a train, and assaults onstaff. Suicides are, by and large, peculiar to LU and the railway network, so aspecialised approach is needed to manage their impact on staff. LondonUnderground is constantly evaluating where and how often suicide attemptshappen and has drawn up information leaflets for staff. Attempts are mostcommonly made at stations near hospitals treating people with mental healthconditions. The company now tries to make staff working at such stations moreaware of the problem, how to spot potential jumpers and to give them theconfidence to approach them.LUhas a zero tolerance policy towards assaults on staff. “If the policedon’t prosecute, we do,” says Carlton. “We have the absolute buy-infrom our managing director and we truly believe we need to drive forward anorganisational approach. It is not just seen as an OH or a medical issue,”she adds. Thisorganisational approach means realising there is a relationship between theservice offered and assault. “Some people just blow up, they just can’tcope – hot day, crowded platform – and they just take a pop. It is totallyunacceptable, but if a train had come two minutes before, it probably wouldn’thave happened. So one of our major organisational drives to reducing assaultsagainst staff is to increase the service we offer. So you get to the absoluteheart of our business. It isn’t just a health and safety thing,” explainsCarlton.Traumaticincidents”Ifyou take an organisational approach, you can start to see how health and safetyis totally core to your business. It just makes a huge difference to theprogress you can make.”Everybodywho has been subject to a traumatic incident is made aware of the supportservices available. Funding has been approved for a trauma support group, whichused to be called a ‘buddies’ scheme, which is being led by OH in conjunctionwith wider management.OHidentifies volunteers and trains them in psychological first aid, and then dutymanagers are given a list of names. “When there is an incident, themanager will look at who the volunteers are. They will say to the person:‘would you like to have someone come and sit with you’, and then they will ringa volunteer who will come in, in their own time.”Thevolunteers are an amazing group of people. They will sit with that person, letthem talk if they want to, and if they don’t want to, they’ll let them be, makesure they are warm and they have fluid, but not alcohol. They’ll explain tothem they are going to be feeling rotten for the next few days and that it istotally normal. They may feel distressed, may not sleep properly and may havenightmares, but it is completely normal,” says Carlton.Employeesare advised to see the trauma team, if they want to, no earlier than three daysafter an incident, but within a week. They are always offered time off work butif they feel well enough to carry on, are not prevented from doing so.Thereis then a fast-track counselling appointment, with four to five sessions takenon average. If an employee is still showing symptoms after 30 days, apsychologist carries out an assessment to see if they need to be treated forpost-traumatic stress, which generally happens in about 2 per cent of cases. Theservice has access to specialist counsellors in this area but, if they are notsuccessful, employees are referred into the NHS.Ina recent initiative, LU is now employing an external consultant one day a week,to look at organisational stress within the company. “Sheis going around and talking to key stakeholders about what we see as big stressareas, but she is also working with a couple of groups who have self-identifiedhaving serious issues, to see what she can do to help them to address thoseproblems, with a view to making some organisational recommendations,”explains Carlton.Drugsand alcoholInthe days of London Transport there was a heavy drinking culture within theorganisation. Nowadays, it is very different. The final element of the OHoperation is the four-strong drug and alcohol team. LUhas a strict drug and alcohol policy that states employees will not drink atwork, will not take drugs at work and will not come to work having taken drinkor used drugs in a way that could put their work at risk. Employees cannot buyalcohol or go into a pub if they are in uniform, and they are not allowed tostore alcohol in any operational building. “Weback it up with a testing programme. For the uniform and safety-critical staff,the tests are unannounced, they can be tested anytime they are on duty,”explains Carlton. “For non-critical employees, they can only be tested ifthey are involved in an incident or if their manager is concerned.”Thecompany tests for 1,000 drugs, with different thresholds set. If you are abovea certain threshold then a medical review takes place, with a company doctorascertaining whether there is an acceptable medical reason. For instance, anemployee might be taking codeine for a headache and have simply forgotten tomention it. There is no acceptable reason for cannabis, cocaine, ecstasy orother class A drug being used.”Ifwe catch you, you are out. But if you declare you have a problem, we willsupport you to an enormous extent. If testers arrive and that is the point you put your hand up, that is toolate,” says Carlton.Employeeswho seek help can be admitted for acute detox, sent on a programme ofresidential treatment or have support sessions. After-care consists of groupsessions twice a week. Ifan employee goes back to work, a formal agreement is signed that specifies thebehaviour expected of them in the future. For the next six months, the employeeis tested a couple of times a week, then reviewed. “Alot of them are still here 10 years later, have been promoted and made a greatsuccess of their lives. The threat of job loss is a very powerful lever,”explains Carlton.Finally,there is OH support for the OH teams. All counselling and trauma staff have formalsupervision through an external provider, which offers whatever psychologicalsupport they may need. Thereis also an external counselling service as well as access to physiotherapy andto company doctors.Keyteam membersHeadof OH Dr Olivia CarltonMedical advisory service Blair CrichtonCounselling and trauma Nigel RadcliffeDrug and alcohol Alison DunnOccupational hygiene Chris Beach Previous Article Next Article Going undergroundOn 1 Sep 2003 in Musculoskeletal disorders, Personnel Today Related posts:No related photos.