Firestyle Magazine: Issue 1 - Autumn 2015

HEALTH & FITNESS
Fitness for role:
staying healthy whilst
working longer
UK government demands have necessitated significant changes within
public services brought about by a legal obligation to balance a
significantly decreased budget. Changes to pension means organisations
have to manage the retention of an older working population with
increasing physical and mental challenges, an unprecedented task
within such a demographic group.
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As a direct result of these
demands to our service, the
Occupational Health Unit
(OHU) and other support
services have had to change
significantly to fully align with the
organisation’s strategic intent.
The service delivery model within
OHU now focuses on efficient
and economic preventative
approaches as opposed to the
traditional, reactive treatment
service. Whilst rehabilitation back
into the workplace following
illness of injury is still a vital
occupational health function,
the service has adapted by using
methods such as education and
health promotion designed to
reduce, and ideally prevent,
sickness absence in the first place
(Hinckley, 2015).
The post-industrial society
we live in today suggests
increased activity outside of
work is necessary to sustain the
appropriate level of health and
fitness required for role and to
remain in employment. Whilst
firefighting cannot be described
as a sedentary job, the significant
decrease in house fires (Knight,
2013) and the increase in
prevention-based activity has
resulted in an overall reduction in
physical activity in the workplace.
This shift has contributed to a
change in OH case load, and
different demands on support
services across the organisation.
Evidence suggests that there
are now fewer musculoskeletal
disorders (MSD), but more
presentations of mental ill-health,
such as anxiety and depression.
The reasons for this trend are
complex, but it is hoped that work
done both nationally and at a
local level within the organisation
have contributed to breaking
down the barriers and stigma
associated with mental ill-health
(MIND, 2015). Poor levels of health
and wellbeing, including low
morale and motivation, impact
on productivity and employee
retention.
It is evident that a holistic,
multidisciplinary team (MDT)
approach to health, fitness
and wellbeing is required. This
will often prevent a very simple
condition developing into
a very costly outcome, and
provides evidence that the
biomedical model is outdated
and needs to be challenged. The
biopsychosocial (BPS) model of
care, first championed by Engel
(1977), provides a fit for purpose
framework through which a truly
holistic package of support may
be delivered, and encompasses a
wider approach to the biological,
psychological and social aspects
of health and wellbeing.
It is therefore imperative that,
irrespective of the backgrounds
and experience of the MDT, the
practitioners adopt the same
principles in order to provide
consistent care. Utilising individual
case management, with
consideration and recognition of
all contributory factors to ill-health
- including obstacles to recovery
- will identify behaviors that affect
the outcome and will provide the
appropriate level of care and
support as soon as possible.
OH teams consist of nurses,
technicians, physiotherapists,
psychologists, and counsellors,
but have historically been led
by physicians. In recent years,
the role of fitness adviser (FA)
has developed within most fire
services nationally. FAs work
closely with clinical staff, often
with responsibility for fitness level
assessments and prescriptive
exercise programmes. However,
there is more scope for FAs, with
an enhanced understanding of
the BPS model, to work as part of
the MDT in all aspect of health in
order to promote a speedy and
safe return to work. The demise of
the obsolete biomedical model
also provides an opportunity to
improve OH services by devolving
responsibility for clinical leadership
away from physicians and placing
it in the hands of other MDT
members who embrace the BPS
model’s holistic viewpoint.
Engel (1977)