Working through: arthritis
The latest in our series on supporting workers with chronic health conditions considers the musculoskeletal condition that is not limited to older workers.
Arthritis is an umbrella term that covers about 200 musculoskeletal conditions affecting ten million people in the UK. These disorders, including arthritis, are the second biggest cause of ill-health absence, resulting in 30.8 million working days lost last year, or one-fifth of all sick leave – minor ailments such as coughs and colds accounted for 34 million days’ absence.
Contrary to public perception, arthritis affects people of all ages. However, some types are more common in older people, so as the working population ages, employers will need to help staff to manage their conditions or face rising absence costs and the loss of experienced employees.
Arthritis Research UK says only 60% of working-age people with persistent musculoskeletal disorders are in employment, even though many more want to work and could do so with the right support. Its website has information on how employees with arthritis can keep working (bit.ly/2pkgbgZ) and the organisation has produced a policy report on working with arthritis (bit.ly/2d27Fg7).
Case law: failure to make reasonable adjustments
In Environment Agency v Donnelly, the Employment Appeal Tribunal (EAT) found the UK’s environmental regulator had breached its duty to make reasonable adjustments by failing to give an employee with osteoarthritis reserved car parking near her workplace. The spaces next to the workplace were usually full by the time Donnelly, who worked flexitime because of her condition, arrived, forcing her to drive to an overspill area ten minutes’ walk away. The EAT rejected the agency’s suggestion that Donnelly should arrive at work earlier to guarantee a suitable parking space because this wrongly put responsibility for making the adjustment on the disabled person.
The most common variant is osteoarthritis, which affects 8.5 million people and causes stiff and painful joints. In advanced cases, mobility is reduced and constant pain makes everyday tasks such as sitting, standing, commuting and typing very difficult.
This is followed by rheumatoid arthritis, an inflammatory disease in which the immune system attacks the body and which affects about 400,000 people. It targets mainly joints and tendons, and symptoms can flare up with no obvious trigger, hindering forward planning.
Severe arthritic pain can lead to low mood and sleep disturbance. In chronic cases, surgery may be needed to replace joints.
Arthritis is not automatically classed as a disability under the UK’s Equality Act 2010. However, a person will be considered disabled if their condition has lasted, or is expected to last, at least 12 months and has a serious effect on their daily activities. If so, there are particular legal duties organisations must comply with. Indeed, a disabled person, can seek redress at an employment tribunal if the employer fails to make reasonable adjustments to working practices and premises, putting the individual at a substantial disadvantage (see "Case law" box above).
People with recurring or fluctuating impairments, such as rheumatoid arthritis, are protected even when their condition is inactive. Also, when assessing whether someone is disabled, employers should discount the effect of medication or treatment the worker is receiving.
According to the charity Arthritis Care’s guide Working with Arthritis (bit.ly/2sJ1lPW): “If you have a significant mobility difficulty (such as problems using public transport or going down steps) as a result of your arthritis, you would be covered [by the Act]. Someone with loss of function in one or both hands, difficulty lifting everyday objects, or with chronic pain would also be covered.”
Even if an employee’s arthritis isn’t severe enough to qualify for Equality Act protection, employers still have duties to carry out workstation assessments and to assess and control other risks. Taking early action to assist an employee, regardless of whether they are disabled under the law, can slow the condition’s development and help to retain employees longer.
Housing association Valleys to Coast (V2C), in Bridgend, Wales, employs about 230 people, many of whom are long-term employees. Health and safety business partner Sue Jones has yet to encounter any with severe arthritis but she points out: “A lot of the people I’ve supported are starting to develop it as they go towards retirement or they’re managing it with medication and just need to feel a bit more comfortable in the workplace. That level of comfort at the early stage is all important.”
She has carried out several risk assessments for maintenance workers who have developed joint problems. “We’ve successfully kept quite a few members of staff in work just by making some simple adjustments,” she says. “It’s about them following agreed processes, giving them things like cushions for kneeling on or a different ladder, or slightly changing duties.
“As far as the office staff are concerned, it’s about making sure we give them the right sort of workstation. There isn’t one size that fits all and we do a lot with different types of chairs, keyboards and mice. I’ve got a desk drawer with attachments they can put on an ordinary pen – people don’t like having things that can be identified as a disability aid. The name of the game is to take a subtle approach that manages their condition in a meaningful way.”
To identify suitable aids, Jones works with the individual to match the equipment to their condition and the job. Finance staff, for example, can be provided with number pads that they can use with either hand.
“We’ve got quite a selection of equipment and someone can have a go with a colleague’s mouse or keyboard when they’re not about. If it isn’t quite right, we get the catalogue out and look at what could be right. I can always reuse it if it doesn’t work.”
She has found the government’s Access to Work scheme a good service – if employees qualify for it. The scheme offers grants of up to 100% to help a person with a disability or long-term ill-health condition but generally this applies only if they have been with an organisation for fewer than six weeks. Otherwise, it may still offer assistance but a medium-sized employer such as V2C must pay the first £500 of the cost of approved equipment or workplace adaptations, plus 20% of any remaining costs.
One former health and safety manager, who asked to remain anonymous, was herself diagnosed with rheumatoid arthritis four years ago. This is her story:
“When I was diagnosed, I had good relationships with the senior management team. They were reasonably understanding when my symptoms were very bad and I could hardly walk but, after going on to weekly injections which made me tired and quite ill, they were not at all supportive. It’s as if they didn’t understand at all.
“It would normally have been my job to research a condition and help the relevant managers to risk assess the employee’s needs to keep them at work. I did this for myself as if it was for someone else, to keep to the agreed policy. I discussed my condition with my direct managers, who were the chief executive and another top manager. They seemed less than interested. I gave them literature on helping people with arthritis in the workplace. I am sure that they never read it and continued to ask me if I was well now, as if they didn’t realise that there wasn’t a cure.
“At one stage, I emailed my manager, reminded him of my condition and asked if I could discuss it with him. He reprimanded me for putting personal data on an email. A little while after this, when asked about my condition and health by HR, he replied that he had no idea what was going on and that I had told him nothing!
“Fatigue was the worst thing, both from the arthritis and the medication. I struggled to fit all the work in, as every day I felt very weak at about 2.30pm. I seemed to recover towards the end of the day and stayed at work until 9pm most nights and worked at home until the early hours most days. Over time this started to take its toll on my health.
“Suddenly, a new CEO came to the organisation and a new management team formed. Things changed greatly for the better – my new manager grasped the concept of being adaptable, he recognised my ability and valued my work, so gave me much more flexibility to come in later in the day. I was given time to work at home when needed. I was able to stay for a few more years and took early retirement when I could afford it, in my own timeframe.”
According to Arthritis Care, there are simple adjustments that can help employees with musculoskeletal disorders remain in work. Many of these are common to assisting employees with the other chronic disorders featured in this series. They include:
modifying the workstation by providing a specialist chair, back rest, foot support, wrist rests, a mouse and keyboard that support the wrists and hands, or voice-activated software
allowing the employee to take short, regular breaks
rearranging work hours to avoid the rush hour or allowing occasional home working
moving the workspace to the ground floor or making it easier to access the current working area
allowing reasonable time off for treatment, assessment or rehabilitation.
It is important that desk-based workers maintain a good posture and there is advice on this in Working with Arthritis. The guide also recommends that employees with musculoskeletal conditions move around every 20 minutes or so.
Health and safety manager Steve Wood, whose 18-year-old daughter has had juvenile idiopathic systemic arthritis since she was two, says that in severe cases “an employer would have to offer flexible working. There will be many hospital appointments and treatments, possible side-effects of medication and days when the employee may not feel well enough to walk or be able to perform tasks such as lifting or carrying. Due to some medication used, such as auto-immune suppressants, there is also a higher risk of contracting communicable diseases, which may be another hazard to consider depending on the workplace and tasks. Wheelchairs and mobility equipment may also have to be accommodated.”
To establish the severity of the arthritis and how the organisation can help the employee to stay in work, it is useful to ask them these questions:
What condition do you have?
What symptoms do you experience?
How does your condition make you feel on a bad day?
What effects do you experience from your medication?
What tasks might you need some help with?
How do your symptoms vary from day to day?
What support would help you do your job?
In advanced cases, it may be helpful to seek assistance from a practitioner registered with the Royal College of Occupational Therapists (bit.ly/2tWQkus). The Employment Medical Advisory Service can also offer advice on workplace health issues, risk assessment and control measures (bit.ly/2tjBQaA).
Some large employers have introduced schemes to promote good musculoskeletal health, identify problems early and offer prompt support to staff with progressive conditions.
Oil producer BP provides its office workers with software that allows them to complete an online workstation assessment and receive a risk or discomfort rating and recommendations on modifying their workstation set-up. Those with a moderate or high risk rating or are in frequent discomfort will be followed up and perhaps referred to a healthcare professional. Another software program encourages regular breaks and movement.
Since the scheme was introduced in 2009, the number of staff with high risk ratings has fallen by more than two-thirds; the number reporting constant or frequent discomfort has also fallen significantly.