The definition of “vulnerable worker” in the changing workplace under Covid-19
I am a scientist at heart. I started my academic life with a BSC in biochemisty and zoology (physiology and genetics to be precise) and later added a medical degree to the list of scientific qualifications and basis for my working life. That was before I turned my attention to employee representation of course and the needs of workers in the various employment situations we have. Whilst to a scientist, evidence based practice is a hallowed principle, as an employee representative we also have to understand workplace dynamics, people, and what drives them – which doesn’t often fit nicely into a petri dish.
As a member of the union PPE subcommittee sent forth by our health union colleagues to engage with the Ministry of Health to ensure adequate PPE was made available to employees across all of health, it has been a challenging time. Managing the “science” as we knew it and as it emerged from changing dynamics overseas, plus more importantly health workers and their patients and clients expectations and utterly understandably anxiety, took persistence. As a union subgroup, getting the Ministry to address the latter was imperative and lets be honest is still a work in progress especially in the aged care and community sectors.
However even within our hospital settings, what we have learnt from COVID-19 will be with us for some time and ultimately change the way we work going forward. For example, COVID has shed a light on inadequate business as usual (or standard operating) PPE usage and availability. As one example when assisting patients to cough, physiotherapists stand in front of the patient, pressing down on their chest as they encourage the patients to cough “well”. That they are in the firing line for droplets and therefore infection is clear and yes they should be wearing a mask as a result. Most of our physiotherapist members have masks available during “normal” times for this purpose but during our PPE work, we found some (not members of ours) that did not and never have had masks made available to them. This needs to be rectified, not for COVID but for normal day to day work. Another example is how we organise our workplaces and the ability to stream patients of different categories and potentially along with this, staff who may be more or less vulnerable to infections and other impacts.
Which brings me to vulnerable workers. Under COVID this “title” has included pregnant workers, those over 70 and those who were immunosuppressed. It would be fair to say that the health sector was caught unprepared for the Prime Ministers announcement that all vulnerable people, including workers should stay home under COVID-19 conditions. It was a blunt tool used at a national level to try and protect people however in the health setting where an estimated 8000 workers are over the age of 70, and for those fit, able and willing to work at a time when we needed them to be available, it created a challenge.
The occupational health physicians leapt into gear and as you know devised an assessment system for vulnerable workers. It was a tool originally written under worse case scenario conditions. We were potentially looking at up to 100 COVID inpatients per hospital where most health workers would come into contact. There was no time for a proper risk assessment to be done. The physicians therefore took a very conservative approach.
As a result of our lockdown what has become apparent is that the high risk did not materialize and with additional time and experience both here in NZ and overseas, a better risk assessment is now possible. And we have developed more means to manage our workplaces from things such as physical changes to buildings, changing our behaviours and the tasks we do, and screening patients.
The occ health physicians have now had an opportunity to perform a more “granular” risk assessment under a principle that those patients posing the greatest risk should be cared for by the staff with the least risk (and appropriate PPE). They are looking at allowing people to return to work where the right measures are in place to get them back to work. This goes so far as in situations such as ICU and ED where the use of pod rostering allows staff with underlying health conditions to stay at work in for example “non respiratory” and “non aerosol” areas.
So in a nutshell we have moved from a concern that most health workers could be in contact with COVID (and indeed most of NZ) to the likelihood that very few health workers will come into contact and with protections in place, most can safely come back to work.
A new vulnerable workers assessment is due out by the end of this week or early next week. We have not yet seen it, but from the sounds of it, they will be reassessing people on a case by case basis. This does take time and with the relatively few occ health physicians, that is inevitable. However we, as they, have been quite clear; it is not for managers to know about your health status and to decide accordingly. Your health information is confidential to you and needs to remain so – hence using doctors in this work (apart from their obvious skills, knowledge and expertise they have in the area!).
The original risk assessment system differentiated different work zones vulnerable people might or might not be able to work in as follows:
- Category 1 work zones: able to work in areas at high risk of COVID-19 exposure and care for COVID patients
- Category 2 work zones: able to work in other clinical areas with low probability of COVID-19 exposure
- Category 3 work zones: able to work in non-clinical areas
- Category 4 work zones: able to work from home or in self-isolation with mild symptoms
Going forward this same type of system will be used, identifying tasks and work areas different (previously) vulnerable people can safely work in.
We will be in touch as the revised risk assessment process is released. For now we thought some history and context might help explain what is likely to happen next. For anyone who is concerned at any change as a result of this new assessment process, as always please get in touch with us for assistance.
Dr Deborah Powell