Pregnancy Risk Assessments

1. Pregnancy Risk Assessments Vanessa Davies Head of Occupational Health Hywel Dda NHS Trust Carmarthen RCN UK Safety Representative Conference October 2011

2. Head of OH for Hywel Dda Health Board • Joint Chair of Welsh NHS OH Forum for 6 years • Twelve years OH experience both in and outside of NHS • Awarded by RCN Best OH Nurse 2006 Personal history

3. Usually by accident…… How do you become a occupational health nurse?

4. Minimum: Registered Nurse (Adults) • Occupational Health qualification, i.e. Diploma or Degree in OH, ideally Specialist Practitioner qualification • Masters for nurse managers Essential – A sense of humour together with lots of life skills & experience! Qualifications…

5. DEFINITION: Occupational Health is the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs.(ILO/WHO 1950) What is Occupational Health…..

6. We are advisors … on just about everything that relates to people and their jobs. What ever job that may be… And that includes any employee who becomes pregnant! That is the accepted definition, what do we do?

7. Lets confirm the obvious….. Pregnancy, just had a baby or breastfeeding are not illnesses!! It is a perfectly normal event, however……. Initially….

8. The legal responsibility for health and safety rests primarily with the employer…… Pregnancy risk assessment

9. Aims of today's workshop: • To provide a brief overview of pertinent legislation • Provide an opportunity to explore the issues relevant to you? • Conclude by identifying a framework for PRA Pregnancy risk assessment

10. Form groups & in 5 – 10 minutes: • Identify the present practice in relation to pregnancy risk assessment in your organisation • Identify what works? • Identify what are the problems? First thing…. Lets start by:

11. Equality Act 2010 • European Directive • Management of Health and Safety at Work Regulations Health and Safety at Work etc Act 1999 • Control of Substances Hazardous to Health regulations • Employment rights Act 1996 Relevant legislation /Directives

12. “Any woman who is, or in the future could be, a new or expectant mother” Which is women of child bearing age who are or in the future could be pregnant, have given birth within the previous six months, or are breastfeeding” (HSE, 2004) Given birth: is defined in MHSW Regs as ‘delivered a living child or, after 24 weeks of pregnancy, a stillborn child’ To whom do the regulations apply?

13. Section 19(5) identifies: A person discriminates against a woman if in the protected period in relation to a pregnancy of hers, A treats her unfavourably: • Because of the pregnancy, or • Because of illness suffered by her as a result of it • Because she is on compulsory maternity leave • Is seeking or has exercised the right to ordinary or additional maternity leave Equality Act 2010Pregnancy and maternity discrimination: work cases

14. These require an assessment of risk: Where there are persons in an undertaking which include women of child bearing age and The work is of a kind which could involve risk by reason of her condition, to the health and safety of a new or expectant mother, or to that of her baby, from any processes or working conditions, or physical, biological or chemical agents…… to encourage improvements in the safety and health at work of pregnant workers and workers that have recently given birth or are breastfeeding.. (Management of Health and Safety @ work, 1999) Management of Health and Safety at Work Regulations 1999

15. Management of Health and Safety at Work Regulations 1999 by regulation 3 (1) an “assessment of such risk” Which is part of routine occupational health surveillance…… What does that mean……

16. “Identification and assessment of the risks from health hazards in the workplace. Which involves surveillance of the factors in the working environment and working practices which may affect the workers’ health. It also requires a systematic approach to the analysis of occupational accidents and occupational diseases” ILO 1985 health surveillance is….

17. A competent person is required to undertake a risk assessment! In most organisations that is not the OH nurse or the H&S manager, however most managers are always a little apprehensive of undertaking the assessment! Stage one- initial assessment NO Yes Are there any hazards present? Inform employee of outcome Assess risks, reduce or remove if possible What do you need to do? This is a good place to start……… HSE’s guidance

18. Specific risk assessment NO YES Yes No Yes No No yes Has a risk been identified Can the risk be removed Remove the risk Monitor and review Action 1 Can the mothers hours/conditions of work be adjusted Adjust conditions /hours Give suitable alternative work on same terms and conditions Action 3 Suspend her from work on paid leave for as long as necessary to protect her or/+ child Action 2 Can she be given suitable alternative work On notification of pregnancy…

19. The range of potential hazards & risks to health is truly awesome in a NHS environment….. There are the obvious…. Health surveillance…

20. Chemicals use and storage • Workload, demands and stress • Working relationships • Environmental risks • Manual handling of people and objects • Aggression and violence • Radiology • Infection control issues….. And the not so obvious……

21. Epidemiological evidence, we know some products have been found to be potentially hazardous to health and that their use needs to monitored • Annual health surveillance programmes to look at respiratory sensitizers‘ and other hazards • Health issues identified during day to day collaboration between different agencies in the Health Board i.e. Health and safety manager, infection control department, the staff or a manager raises a concern How are the hazards identified….

22. Physical risks • Movements & postures • Manual handling • Shocks and vibrations • Noise • Radiation Chemical agents • Toxic • Mercury • Cytotoxic drugs Biological agents • Infection Working conditions • Facilities • Mental/physical fatigue • Stress (inc postnatal depression) • Temperature • Working with visual display units • Working alone • Travelling • Violence • Working and PPE • nutrition The European directive lists the following hazards

23. Please form groups and for about 10 minutes consider the following scenarios!

24. For the pregnant, newly delivered or breast feeding woman: There are the responsibilities of the: • Employer • employee How are they managed….

25. To notify the employer that she is: pregnant, newly delivered or breastfeeding Or Advise further if she continues to breastfeed beyond six months May need to provide certificate from midwife or general practitioner Employee

26. To ensure that appropriate and current policies related to staff health and safety are formulated and implemented • Competent person to undertake the risk assessment to identify hazards ideally in collaboration with the employee • To implement any adjustments to address any identified hazards • The employee should be offered a health assessment during her pregnancy • Re-evaluate any risk assessments if there are any changes • When an employee is breastfeeding, the employer should ensure she has access to appropriate facilities and be protected from identified hazards • If in doubt then contact your occupational health service Employer responsibilities:

27. If following risk assessment, these hazards cannot be avoided, the employer will need to: • Alter working conditions or hours of work, if not • Identify and offer suitable alternative work, if not then the employee is to be suspended on full paid leave from work! Employer : Management of health and safety regulations 1999

28. Breastfeeding • Provide appropriate rest areas for pregnant employees • Recommended to provide an appropriate environment for mothers to express and store milk Night work any new or expectant mother who works at night, who has a medical certificate stating that night work could affect her health and safety: • Offer suitable alternative daytime work or • Suspend her from work, on paid leave as long as is necessary to protect her health and safety If the risk arises from work! Special considerations…..

29. All employers have a statutory responsibility under Section 2 (1) of the Health and Safety at Work Act (1974) 1 to create as safe an environment as is reasonably possible. The Management of Health & Safety at Work Regulations 1992 and 1999 specify these responsibilities:

30. The relevant legislation requires: • Safe environment for pregnant employees • Ensured by a risk assessment undertaken by competent person • If suitable adjustments or an alternative role cannot be identified, suspend on full pay • Documented and evaluated as needed by responsible manager Summary …

31. Any questions….?

32. HSE (1992) Management of health and safety at work, management of health and safety regulations 1999 Approved code of practice and guidance, HSE • HSE (2002) New and Expectant mothers at work. HSE • Lubick, N (2011) Advising parents in the face of scientific uncertainty: An Environmental Health Dilemma. Environmental Science and Technology, Nature and Earth • HSE: Biological agents: Managing the risks in laboratories and healthcare premises: The advisory Committee on dangerous pathogens References