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Hi All, Tracey - you haven't said whether her shoulder/wrist problems are ongoing to part of an active 'flare' or whether her performance is an issue or not? I'd be intrigued to know when she was diagnosed as if only diagnosed recently then she may have years of pre-existing joint damage making her more prone to CTS and other problems. Her attendance is good. In many companies she wouldn't need to take holiday but has chosen to for hospital treatment, so depending on company policy I would expect HR to decide whether that holiday day should be given back and also she may come under the Equality Act so is entitled to time off for treatment and not be put to detriment. Well, I'm going to disagree with some of the comments raised so far. I'll apologize in advance for getting on my soapbox but I'm rather passionate about RA so here goes...... With RA there are so many unknowns. Why should she not work in factory setting? How do you know her work is making her symptoms worse or not? How do you know if the CTS/ shoulder pain is caused by the disease process (joint erosion) or her work - you don't and you will never know. She is the expert in her condition. She needs to work. With inflammatory arthritis symptoms the activity often helps manage pain (many are in more pain in sedentary jobs), promotes mental health and sleep. Yes she may require injections in her joints to 'keep her going' but is that really any different to a client requiring osteopathy for a bad back or steroid injections for elbow/shoulder problems?! In the factory setting I'm sure you have many staff with chronic msds/pain but no 'label' who keep working and probably have a worse attendance record. The challenge for anyone with a chronic condition is managing the symptoms to enable them to continue working. She sounds to me to be doing a sterling job. I find it a difficult balance sometimes and I have to be aware of not over-protecting clients. I can only ensure she has robust information to make informed choices and she has had appropriate investigations and referrals where required. (The drugs combos for RA are of the disease modifying and biologics variety and are quite complicated these days tbh.) The only thing that you have not referred to is completing a robust risk assessment in relation to her condition and her work. The key to rheumatoid arthritis is to think of the 4 Ps - pain (stretching, need for splints, orthotics), joint protection, pacing & planning etc which all aim to reduce the energy demands on the body to reduce fatigue from the inflammatory process within the body. Her workstations will need to be assessed to ensure that her posture is as neutral as possible to reduce pressure on joints (this is no different to anyone else) and review the job rotation setup. She may require more frequent rotations or short pacing breaks. Has she been advised to wear splints whilst working and does she have working splints? For ideas to consider see presentation link below. I have been in similar situation recently with a lady with severe pain including deformed joints in her hands as a result of working as a sewing machinist for the last 30 years. She is in pain, her work aggravates it, we cannot make any further changes to her workstation, there is no opportunity for job rotation. She knows her hands are better when she is away from work but she cannot afford to go part-time (it has been offered to her) or retire and jobs are scarce...... she is able to work and performing to a high standard, she does not take time off-sick, she has sought advice from her GP to rule out any under-lying pathology such as RA and better analgesia than long-term ibuprofen and through open discussion her informed choice is to continue for as long as she can. There is no point in sending her to an OHP (not that we have one) as we already know the reality (she is the expert in the reality of her condition - what difference is an OHPs view going to make.........?) Who can say whether her condition is caused by her work or by her own genetic makeup (family hx of severe OA.) The above is on record. The management team will have to deal with the situation if and when she becomes unable to work or her performance is reduced. It is very rare in my experience to say someone is unfit for a job role, they can either do it to the required standard with reasonable attendance or cannot. If they cannot then they have to be managed early on in the probationary period and out if no improvements seen (not used often enough IMHO) or for longer-standing employees, through the capability route. If they have a long-term health condition they will often self-select out if they can no longer tolerate the work. Equality and human rights legislation no doubt have a bearing in relation to a 'legal right to work.' BTW - a reminder of the good work that NRAS (National Rheumatoid Arthritis Society) does. They ran workshops (which I was lucky enough to be involved in) aimed at supporting people with RA in the workplace. Delegates included plumbers, nurses, administrators, factory workers, farmers (men and women of all ages). The resources and information is available on their website...... :0) http://www.nras.org.uk/workwise/welcome_to_workwise.aspx http://www.nras.org.uk/workwise/expert_films/catherine_tye.aspx see video clip and presentation slides re things to think about and topics that you can discuss with the employee concerned - to ensure that everything has been considered to assist her in managing her condition. I would suggest record in her notes then monitor 2-3 monthly. (The Equality act animation is good regarding pacing in inflammatory disorders) Hope that helps! Kind Regards, Catherine Catherine Tye RN SPOH PgDipOSH Health, Safety and Wellbeing Practitioner Harmony Health & Wellbeing | email: [log in to unmask] | www.harmonyhealthandwellbeing.com Date: Wed, 18 Jan 2012 20:32:36 +0000 From: Tracy Turner <[log in to unmask]> Subject: Painful joints Good evening. I have seen a lady today who works in the meat factory. Has been diagnosed with rhuematoid arthritis and carpal tunnel for several years prior to starting in the factory. She was advised at post offer that this type of role may not be suitable for her but she had woked 12 months at the same factory with an agency and had not reported any problems. The Busienss were advised of this. She was advised to report any onset/increaase of symptoms. In November she went to the rhumatologist and had injuctions to both shoulders and the second lot of injections to wrists. if the wrists do not improve she will require surgery. She did not report the pain just asked for annual leave days so she couldhave the injections. She is insistant she can do he job. She has not gone sick and in fact had injections all done on same day to prevent absence. She is only 40 and I have done my best to advise her that she should not be working in the factory environment. She is adament taht she can do her job and that she does not require any adaptations. Apparently her GP agrees with me. Apart from documenting this what else can I do ? I am sure people have a legal right to work even if it is exacerbating health. Any comments welcomed as ususal. Thank you. ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ------------------------------ Date: Wed, 18 Jan 2012 20:48:26 +0000 From: sharon naylor <[log in to unmask]> Subject: Re: Painful joints If she has been referred to you are you required to report back to management? If you are I would give my opinion and take it from there. Mention that she is states she can do the job, (I take it this is repetitive work?)Gettin something in writing from GP may help, as would OHP opinion.If she has not been referred and she has been to see you voluntarily - well thats a thorny issue I think.... > Date: Wed, 18 Jan 2012 20:32:36 +0000 > From: [log in to unmask] > Subject: [OCC-HEALTH] Painful joints > To: [log in to unmask] > > Good evening. I have seen a lady today who works in the meat factory. Has been diagnosed with rhuematoid arthritis and carpal tunnel for several years prior to starting in the factory. She was advised at post offer that this type of role may not be suitable for her but she had woked 12 months at the same factory with an agency and had not reported any problems. The Busienss were advised of this. She was advised to report any onset/increaase of symptoms. In November she went to the rhumatologist and had injuctions to both shoulders and the second lot of injections to wrists. if the wrists do not improve she will require surgery. She did not report the pain just asked for annual leave days so she couldhave the injections. She is insistant she can do he job. She has not gone sick and in fact had injections all done on same day to prevent absence. She is only 40 and I have done my best to advise her that she should not be working in the factory environment. She is adament taht she can do her job and that she does not require any adaptations. Apparently her GP agrees with me. Apart from documenting this what else can I do ? I am sure people have a legal right to work even if it is exacerbating health. Any comments welcomed as ususal. Thank you. > > ******************************** > Please remove this footer before replying. > > OCC-HEALTH ARCHIVES: > http://www.jiscmail.ac.uk/lists/occ-health.html > > CONFERENCES AND STUDY DAYS: > http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ------------------------------ Date: Wed, 18 Jan 2012 15:55:23 -0500 From: Tracy Turner <[log in to unmask]> Subject: Re: Painful joints Hi The lady was referred to me as the Business were concerned regarding her health as they knew she had recieved the injections in her wrists and shoulders. She is fully open to the Business about her condition. She is a very good worker. Her determination keeps her going but at such a high cost. Yes it is repetative workbut she does not need to lift more than 5kg. -----Original Message----- From: sharon naylor <[log in to unmask]> To: OCC-HEALTH <[log in to unmask]> Sent: Wed, 18 Jan 2012 15:48 Subject: Re: [OCC-HEALTH] Painful joints If she has been referred to you are you required to report back to management? If you are I would give my opinion and take it from there. Mention that she is states she can do the job, (I take it this is repetitive work?)Gettin something in writing from GP may help, as would OHP opinion.If she has not been referred and she has been to see you voluntarily - well thats a thorny issue I think.... > Date: Wed, 18 Jan 2012 20:32:36 +0000 > From: [log in to unmask] > Subject: [OCC-HEALTH] Painful joints > To: [log in to unmask] > > Good evening. I have seen a lady today who works in the meat factory. Has been diagnosed with rhuematoid arthritis and carpal tunnel for several years prior to starting in the factory. She was advised at post offer that this type of role may not be suitable for her but she had woked 12 months at the same factory with an agency and had not reported any problems. The Busienss were advised of this. She was advised to report any onset/increaase of symptoms. In November she went to the rhumatologist and had injuctions to both shoulders and the second lot of injections to wrists. if the wrists do not improve she will require surgery. She did not report the pain just asked for annual leave days so she couldhave the injections. She is insistant she can do he job. She has not gone sick and in fact had injections all done on same day to prevent absence. She is only 40 and I have done my best to advise her that she should not be working in the factory environment. She is adament taht she can do her job and that she does not require any adaptations. Apparently her GP agrees with me. Apart from documenting this what else can I do ? I am sure people have a legal right to work even if it is exacerbating health. Any comments welcomed as ususal. Thank you. > > ******************************** > Please remove this footer before replying. > > OCC-HEALTH ARCHIVES: > http://www.jiscmail.ac.uk/lists/occ-health.html > > CONFERENCES AND STUDY DAYS: > http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ********************************Please remove this footer before replying. OCC-HEALTH ARCHIVES:http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS:http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ------------------------------ Date: Wed, 18 Jan 2012 21:08:58 +0000 From: Carr Barnes <[log in to unmask]> Subject: Re: Painful joints Is the work just going to cause symptoms that she feels able to cope with or is it actually going to cause physical damage? Those 2 points and their potential impacts on attendance need to be outlined to management for them to action as they choose. This is a case I'd definitely progress to a physician as a medical assessment is required. Regards, Carr On Jan 18, 2012 8:58 PM, "Tracy Turner" <[log in to unmask]> wrote: > Hi > The lady was referred to me as the Business were concerned regarding her > health as they knew she had recieved the injections in her wrists and > shoulders. She is fully open to the Business about her condition. She is a > very good worker. Her determination keeps her going but at such a high > cost. Yes it is repetative workbut she does not need to lift more than 5kg. > > > > -----Original Message----- > From: sharon naylor <[log in to unmask]> > To: OCC-HEALTH <[log in to unmask]> > Sent: Wed, 18 Jan 2012 15:48 > Subject: Re: [OCC-HEALTH] Painful joints > > > If she has been referred to you are you required to report back to > management? If you are I would give my opinion and take it from there. > Mention that she is states she can do the job, (I take it this is > repetitive work?)Gettin something in writing from GP may help, as would OHP > opinion.If she has not been referred and she has been to see you > voluntarily - well thats a thorny issue I think.... > > > > Date: Wed, 18 Jan 2012 20:32:36 +0000 >> From: [log in to unmask] >> Subject: [OCC-HEALTH] Painful joints >> To: [log in to unmask] >> >> Good evening. I have seen a lady today who works in the meat factory. >> > Has been diagnosed with rhuematoid arthritis and carpal tunnel for several > years prior to starting in the factory. She was advised at post offer that > this type of role may not be suitable for her but she had woked 12 months > at the same factory with an agency and had not reported any problems. The > Busienss were advised of this. She was advised to report any > onset/increaase of symptoms. In November she went to the rhumatologist and > had injuctions to both shoulders and the second lot of injections to > wrists. if the wrists do not improve she will require surgery. She did not > report the pain just asked for annual leave days so she couldhave the > injections. She is insistant she can do he job. She has not gone sick and > in fact had injections all done on same day to prevent absence. She is only > 40 and I have done my best to advise her that she should not be working in > the factory environment. She is adament taht she can do her job and that > she does not require any adaptations. Apparently her GP agrees with me. > Apart from documenting this what else can I do ? I am sure people have a > legal right to work even if it is exacerbating health. Any comments > welcomed as ususal. Thank you. > >> >> ********************************** >> Please remove this footer before replying. >> >> OCC-HEALTH ARCHIVES: >> http://www.jiscmail.ac.uk/**lists/occ-health.html<http://www.jiscmail.ac.uk/lists/occ-health.html> >> >> CONFERENCES AND STUDY DAYS: >> http://www.jiscmail.ac.uk/cgi-**bin/filearea.cgi?LMGT1=OCC-**HEALTH<http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH> >> > > > **********************************Please remove this footer before > replying. > OCC-HEALTH ARCHIVES:http://www.jiscmail.**ac.uk/lists/occ-health.html<http://www.jiscmail.ac.uk/lists/occ-health.html> > CONFERENCES AND STUDY DAYS:http://www.jiscmail.ac.** > uk/cgi-bin/filearea.cgi?LMGT1=**OCC-HEALTH<http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH> > > ********************************** > Please remove this footer before replying. > > OCC-HEALTH ARCHIVES: > http://www.jiscmail.ac.uk/**lists/occ-health.html<http://www.jiscmail.ac.uk/lists/occ-health.html> > > CONFERENCES AND STUDY DAYS: > http://www.jiscmail.ac.uk/cgi-**bin/filearea.cgi?LMGT1=OCC-**HEALTH<http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH> > ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ------------------------------ Date: Wed, 18 Jan 2012 21:13:57 +0000 From: janet oneill <[log in to unmask]> Subject: Re: Centre for Mental health - Impact on Depression training Hi Try the above and;- WORKPLACE INTERVENTIONS FOR PEOPLE WITH COMMON MENTAL HEALTH PROBLEMS - BOHRF this is lengthy but good and has a section on managers Also there is quite a lot of research on changing behaviors with training if you google. The Sockal document has information on training for behavior change although not specifically aimed at managers hope this is of some help even if it is a bit oblique janet On Tue, Jan 17, 2012 at 1:42 PM, Susan Gorton <[log in to unmask]>wrote: > Hi Team**** > > I am looking for anyone who has encounterd the Impact On Depression > training run by the Centre for Mental Health. In particualr anyone who has > done any evlauation around it. I know one of my OH colleagues out there has > done some work in the North west NHS sector.**** > > Also does anyone have any references on the value of training to change > attitude or behaviour.**** > > In case it isn't transparent, I am doing research, part of which will be > to pilot this training for managers and see if it fills an important gap in > the knowledge, attitude and subsequent behaviour of managers with regard to > managing employees with common mental health problems.**** > > Thanks in advance**** > > regards**** > > Sue**** > > ** ** > > ********************************************************************************************************* > > This message may contain confidential information. If you are not the > intended recipient please inform the sender that you have received the > message in error before deleting it. > > Please do not disclose, copy or distribute information in this e-mail or > take any action in reliance on its contents: to do so is strictly > prohibited and may be unlawful. > > Thank you for your co-operation. > > > ********************************************************************************************************* > ******************************** Please remove this footer before > replying. > > OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html > > CONFERENCES AND STUDY DAYS: > http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH > ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH ------------------------------ End of OCC-HEALTH Digest - 17 Jan 2012 to 18 Jan 2012 - Special issue (#2012-19) ******************************************************************************** ******************************** Please remove this footer before replying. OCC-HEALTH ARCHIVES: http://www.jiscmail.ac.uk/lists/occ-health.html CONFERENCES AND STUDY DAYS: http://www.jiscmail.ac.uk/cgi-bin/filearea.cgi?LMGT1=OCC-HEALTH