Good morning, ladies and gentlemen. Well done for getting up so early on the third day of the conference. I don't know about you, but it's about time to go home. We're all sick of COVID. So between the SOM and ACOM, we did a session where we sort of looked at the learnings from it, but tried to look at it from a slightly different angle with looking at specific sectors. So in theory, we have five speakers today. Myself, that's me there. I'm Rick Armone, CMO and co-founder of Zello, and vice president registrar of the faculty in the UK. We have Bob Bourgeois, Will Ponsabree, Sridhar Patani. I'll let each of them introduce themselves as they come along. Doug Martin, our current president, was also meant to be speaking, but we'll see what happens. So let's crack on. There's a lot to cover, and we'll do a panel session at the end. And we're also very honoured to have Professor Steve Nimmo, who's the president of the faculty in the UK, to join us on the panel session. So nothing to declare. This sort of tickled me when I read this, you know, that we had gotten rid of infectious diseases. No, we certainly haven't. In fact, we've had more outbreaks and more infectious diseases, outbreaks in the last 15 years than we've probably ever had, but that's a whole different lecture. I always like this slide. Where are you at at the moment? So hopefully, I don't know, somewhere between disillusionment and reconstruction, I think. I think we're all disillusioned. Working through the grief of COVID, I think we've worked through the grief, but I always quite enjoy that slide. Right, straight into the, from the UK, we, now everything I say is my own opinion, not the opinion of the faculty, not the opinion of Zello, because I'm going to try and not get political, but it's kind of hard not to get political, because, and we'll hear what was done in the US, but actually in the UK, a lot of the decision making was driven by political expediency rather than the clinical evidence, and the mask wearing was a classic example of that, but there was numerous examples. The UK was poorly planned. We, unlike Asia, and the countries that did well during COVID were the ones that learned from the SARS pandemic and had plans in place to deal with it. Well, we had it sat on the shelf, but we didn't follow it, and that was sort of the beginning of the, of, you know, the beginning of the end for, for the UK, because our, the preparation in the UK was, was focused purely on influenza style pandemic, and that was destined to fail. We didn't read the global science. I can remember sitting in the UK looking at what was going on in Italy, and then Germany saying, this is coming our way, and we could all see it, but actually, we, and you'll see in a minute when we actually shut down. Unofficially, but not unofficially, that, you know, it looked like the UK government were going for the Swedish approach initially, the herd immunity, and then realized, no, that may not be the right way to go. We didn't close our borders, and we had a significant level of mortality in the UK as the US did, and I'll show you some charts to show how we, we, we similarly perhaps didn't manage it as well as we, as we could have done, and when you compare that to other countries, what we did find was, you know, only between 10 and 60 percent actually adhered to the self-isolation rules, and there you see, I wanted to sort of benchmark the UK and the US, and you can see how similar our profiles were, so I'm interested to hear from our US colleagues whether they agree or disagree with how we did in the UK, and then at the bottom, you can see how the countries that did plan, actually, how well they did it, and putting that into numbers, I mean, I find this slide really, really scary, so globally, you know, deaths per million, 39.1, and then you look at, you know, the US at 251, and the UK, and the UK was even worse than Sweden, and that's sort of why I think we can be fairly scathing on the negative lessons that we learned, and there was a lot of confusion on mask wearing, very much mixed messaging, people were told just to wear cloths over their face, and we all know that's, that's completely useless, I mean, even, you know, even surgical masks now shown that, you know, are okay, but not good enough, you know, minimum FFP2, and just a very interesting lesson, because, you know, we can spend all day talking about masks, how effective they were, et cetera, all the data's now coming out, and it's quite interesting to see, but this was, so the orange there is Austria, and then you can see that the UK is the purple, so Austria imposed mandatory mask wearing, March 21st, 2020, and look how their incidence rate rapidly went down. There may be another confounding factors, but, I mean, that is a significant fall, so whatever we think about mask wearing, you know, there is a hard copy version of how it, how it can go well. In the UK, the vaccination programs, there was a huge disparity between the ethnic groups, and I'm going to show you a slide in a minute, which is, which is really upsetting, but look at the vaccination rates, you know, the, the, the white Caucasians, 95%, ethnic groups down to 55%, and because of that, significant worse mortality and health outcomes for socioeconomic lower groups, and also the, the ethnic groups, so, you know, as they call the inverse care law. The UK abandoned contact tracing, which then, you know, able to contain, and it was, it then, we had shut down a lot longer than a lot of other countries, and that was, that was probably why. We didn't have particularly good local restrictions. They, they failed, and a lot of that was, was, was based on poor public messaging. The public health measures were, again, also introduced late, removed too early, and inconsistently applied, so it's not particularly good for you, and in the UK, interestingly, you know, Scotland have their own devolved government. They're not independent, and hopefully they never will be, but anyway, but they have their own devolved government, and they, their approach, their, their minister, their leading minister, her approach compared to the London government was completely different, and the compliance and the understanding between, within the same nation was significantly different, and our CMO is the gentleman on the left of the screen, Chris Whitney, and you can see the poor face of Chris Whitney. He, he did an amazing job, how he, you know, as I mentioned, a lot of it was politically driven, and he was there in the, in the middle of government, trying to, to make it clinic, you know, evidence-based and, and risk-based, but you were not immune from that either. I think, I'm sure you all remember the infamous press conference about injecting bleach, and inject, injecting ultraviolet light, and you look at the picture of, of, of the CMO there, what do you do in that situation? This, this slide is really upsetting, and it's showing, as I mentioned just previously, the, the, the difference between the ethnic groups in the UK, and white British is, is the red line, and you can see, you know, black African male, four times the level of mortality, and in any civilized nation, you know, that, that should not be happening, and you can see some of the, the Bangladeshi and the black Caribbeans, and that's, that's, in many ways, that's one of the legacies of how UK managed COVID, and it's not a very nice, nice slide. One of the big problems we had was a lot of the elderly were dumped out of the hospitals, straight into care homes, and guess what happened? You know, it just went like wildfire through, through the care homes. They hadn't had testing before they were moved there, so, you know, they estimate, as you can see there, 50,000 extra deaths as, as a result of that. I'm going to skip straight to the bottom, because, you know, we have a, we have a short period of time. We're very interested to hear your instance of long COVID here in the US, but you can see in the UK, we're sitting at about 5% of cases, and 25% of those are absent from work. We don't have the rehab programs to get them back, whether it's vocational rehab or, or, or whatever, so they are, they are sat at home, and that kind of feeds into, into, into the well-being aspect of, of the population in the UK, and really, on the right, there's just a list of the issues that, that impacted upon the well-being of people within, within the UK, and on the left is actually some data showing that. So, you know, people with existing mental health conditions, 87% had an episode of mental health illness, and the average, as you can see there, sitting at 30%, and alcohol consumption went hugely up, as did domestic abuse. Domestic abuse during COVID was a huge concern, and again, we're very interested to hear what our US colleagues say, but there's got to be something positive out of it, has to be something. The, our procurement process in the UK, we got lucky, I would say. The government were brave, brave or lucky, who knows, but they ordered about seven or eight different kinds of vaccines, bulk bought, on the hope that one of them would work, and one of them did, so, so they were lucky. So the vaccination rollout in the UK is what saved the UK government. You saw the mortality rate per 100,000. Imagine what it would have been if we hadn't had such a good vaccination campaign, and we got a 93% uptake, so that very much saved, saved the UK. Another nice thing that came out of it, and you can see at the bottom, it's called Clap for Carers. Every Thursday, everybody got outside their house and clapped, and you could hear all over the city and all of the towns were clapping for the people who were, you know, we were all stuck at home, who were at work looking after those, those who were unwell. And the, the, the, the, the public wearing of the masks was pretty good. I think, you know, people, people really pulled together. I mean, you know, they sort of say it was like the Second World War. You know, people pulled together, the communities, you know, met in the streets, had street, I'm not going to say parties, but had street gatherings, because it was the only place you could meet. And the lockdown had pretty good, pretty good compliance. Our NHS was phenomenal, absolutely phenomenal. The rate that they worked to, to keep people alive. One of the things that we did in the UK, they were called the Nightingale Super Hospitals. So you can see on the top right hand screen, that was the London one. You know, they built super hospitals with, with 1000 beds in them. Turned out we didn't need them. But that was pretty good planning in case we did. And as I mentioned, the community cohesion and support really was a big part that, that came out of that. To save the economy, our Chancellor did a thing called a furlough scheme, where he paid companies to keep people employed when they were sat at home, particularly the bar workers, and the people that were in that, you know, in the retail, in that industry. And I mean, it cost $100 billion. But that saved our economy. So that was pretty well run, as was, they gave businesses loans to get them through the patch. So we didn't fall off a cliff, cliff economically. We actually looked after the homeless quite well. We didn't look after the poor or the ethnic minorities, but we looked after the homeless. And the remote working, we switched over pretty quick to that. And that actually went quite well. So to split things up, Will, I thought, should we go? Should we do US, UK? Bob, do you want to, do you want to come in now? So we'll do a panel session at the end. So we've got five of us for you to ask us some challenging questions. So I'm sure you all know Bob Bourgeois. He probably doesn't need to introduce himself. But there you go, Bob, I will let you, I'll let you load up. Thank you, Carl. I'm Bob Bourgeois from ACOM. I'm immediate past president for the next 24 hours. I'm going to go ahead and give you some lessons learned from the South. Someone just stopped me and said, you have a really funny Australian accent. And I said, why is that? He said, well, we thought you were giving a talk about things from the South. Okay. So anyway, I'm, I work down in the oil field in Louisiana. And the Gulf of Mexico is our playground. Trying to get the speakers notes off of there. I'm trying to get speakers notes and just go to slideshow. It's not letting me click on it. There it is. Okay. So anyway, I don't know how many of y'all, you know, looked at all the updates that came out weekly on, on how to take care of people in helicopters going offshore and commercial divers working underwater and saturation and all the other, you know, volumes of data that was out there, how to protect them, which there was none. So as usual, you know, occupation medicine folks had to be pretty agile. So everything we did was kind of look at what's out there, filter out the 95% that made no sense and try and figure out if something's way over here and something's way over here, there's gotta be something in the middle that makes, makes it really, you know, more, more useful. And, uh, and we talked to each other. So a lot of us talked, uh, every day, multiple times a day. And sometimes we'd have little small group sessions on how to figure out different things. So the things that we had to look at, because we weren't allowed to sit home and shut things down because we had to keep things running as as all of, you know, so offshore energy, if you have between 100 and 300 persons on an offshore installation, we're flying helicopters with 18 passengers, two pilots, hour and a half or so up to three hour flight each way. How do you protect them? The hitch duration went from 14 and 14 to 21 21 actually 2028 days at a time and sometimes more. We tried to do some home quarantine before they went out. That didn't do anything at all. Uh, hotel quarantine. Some of the company set up five hotels in one area and everybody come in, you do questionnaires, swab them, put them in individual rooms, individual feedings, everything, and basically an isolation for five days before they go out. And they swabbed them every other day for five days and pre flight. You also got swabbed again when you got to the asset. So it was a pain and a lot of them kind of, you know, wonder what can we do different? So we can probably put like a little conduit in there so we don't touch anything on the way back next time. But they were getting a little bit tired of being swabbed so many times. The serial screenings continued throughout the hitch. And in any time there was a breakout, you had to do larger screenings and would do that area of the asset and bigger and bigger until we had all negatives. And at the time you had a medevac each person in individually because the helicopter crews didn't want to do more than one at a time. So sometimes we had a three day backlog trying to get people off and then you're trying to get other folks back. So it was a really, really interesting time. And then once somebody's had it, what do you do with them? When do you get them back out? When are they no longer infectious? And then we came up with some pretty good little game plans because we figured if you've just had it and you've recovered and you can't get it again for maybe 90 days, you're now one of our superstars. We can put you anywhere and not get everybody else worried. So we started trying to figure out, you know, we had color tags for who had what, when, and when their 90 days was up and on and on and on. And so we were able to go from single rooms to double rooms, quad rooms sometimes, and have single rooms for folks that had symptoms to get them in or whatever. So the logistics people wanted to kill us, but operations thought we were pretty cool. Maritime pilots, the busiest port in the US is Houston. 24-7. You have one boat in, one boat out. The smaller boats always in the calmer waters. The big boat has multiple, multiple pilots in single rooms. But the AC system is not a closed system for each room. So we were trying to figure out ways to make that better. We went through all the cleaning and all that everybody was recommending way back. We had masking. And for all these folks, we had them in N95s without the exhaust valves. The boat crews, I mean, you're getting on a vessel that's just made three other port stops. And then while they're there, they say, you know, the master has a little scratchy throat and cough and he's starting to look a little rough. Anybody else sick? Well, they got 16 of them in the beds. They can't get out of bed right now. So a few other folks are sick too. It's like, well, thanks for the heads up. So we were trying to protect the pilots and, you know, they come alongside the ship, climb up the ladder, get up there and have to tell the captain what to do. So we had them trying to stand on a bridge wing out in the air because the solution to pollution is dilution. So we had them out there in fresh air, trying to, trying to stay away from anybody. So then, you know, when that started kind of going through some of them, we had to do the same thing about the creativity with who had what, when, and when they can come back and who's not going to get somebody else sick. So we bump those around too. Gas pipeline control rooms. If you don't have folks in the control room 24-7, you have to shut the pipeline down. On these oil platforms, you don't have somebody on there 24-7, you shut it down. And you have minimum manning criteria for all these places. So if you shut down natural gas pipelines, would you also shut down utilities? If you shut down utilities, what goes off at your house? Everything. So, you know, without doing the things that we did, everybody would have been in the cold, dark and hungry. But thanks to the folks in OCMED that responded to this differently from the folks that just said, stay home, everything's going to be okay. We made it look a lot easier. So what do you do with these folks again? Again, serial screening, at-home quarantines. And actually, they kind of knew the criticality of their positions and knew that if they got sick, they couldn't go in. But then we also started making some remote rooms and moving people out. So each of them had their own office, and we had them where they had their own air condition. We had some of them in single buildings. They had their own air condition, own bathroom, own eating area. They all had all these questionnaires every day with apps on their phone. If anything pops up, one of the yacht health nurses would call and follow up with them that day. We had screening done that day. So again, once we got all this stuff done, it kept everything running, but it had to be very, very agile, very, very creative, trying to figure out who can you put work and where and with whom. Commercial dive teams. Dr. Alamo is an expert on some of the commercial diving in the US. And he'll tell you, you put folks down 800 feet down and somebody gets sick. What does COVID do if you're under pressure? And really, we were treating symptoms, not really. It wasn't that we gave you something, it wiped it out, and all of a sudden, tomorrow you feel better. How many days does it take to get up from 800 feet? About one day. So if one person's sick, everybody in that chamber is going to get sick. And if they crash, you can't just go in there and get them out, because they die. So that was a big issue for us. So those guys got, we quarantined them for days ahead of time and kept testing them and testing them. But also, you have the crews, it's a dive boat most of the time, unless you're diving off a platform. So you have all the boat crew, and you have to take care of all those folks and make sure they're not spreading it around somewhere else. And then the tenders and the chamber operators that can come in and out, if they have to go in the airlock, they'll go get somebody. They're stuck in there with them until they come up, too. Because they're at the same pressure, they take the same time to come up. So a whole bunch of challenges. Nobody wrote a book on any of it ahead of time so we could figure it out. But we didn't kill anybody, which is great. We didn't shut any asset down at all. I mean, one of the big platforms got shut in for a couple of days early on while they figured out what to do. And then once they got all of us mobilized to come help, nothing else shut down. So when we presented some of this to OSHA, and to NIOSH, and to ASPR, they were saying, well, it's pretty interesting. We're still working from home. And so when next time this happens, you'll need to get us on a speed dial. And we won't be doing so many things the other way. Questions? Or are we going to do questions after? OK. All right. Thank you all. Good morning, everybody. Before I start, I'd just like to thank ACOM for their kind invitation to come and speak. And also for their generous hospitality in hosting us during the conference. It's really a special privilege to come over here to the US. And thank you very much. What I want to talk about is health risk assessment, and how that worked during the pandemic, or didn't. Health risk assessment, as we all know, is a process whereby we identify health hazards, we assess them, put in place controls, and manage them. Under UK law, it is a legal requirement. And our health and safety system is risk-based. Which is in a contrast to the United States, where your health and safety system is more rule-based. And therefore, having proper risk assessment is absolutely critical to the management of health and safety in the UK. And a lot of our laws don't actually tell you exactly what to do. They say that you have to have a proper risk assessment in place. And therefore, you need to have competent people to actually administer that. As we know, when COVID kicked off, we had a new biological hazard. We didn't know very much about it. So we made assumptions. Some of the assumptions we made were correct, and some not so much. And I think in the West, certainly in Europe and the UK, we assumed that the COVID virus was going to behave like influenza. And we applied the influenza controls. And in fact, in the UK, our pandemic planning was all based around an influenza pandemic. I think in Asia, where they had experience of SARS, and their planning was more SARS-based, they applied SARS-based controls. And as I think was shown in the longer term, COVID was more similar to a SARS virus than an influenza virus. And I think that's possibly one of the reasons why they did better early on. So some of the controls, we looked at fomite controls, looked at aerosol spread. So lots of emphasis on hand-washing. And there was lots of discussions, as Ricard mentioned, about mask wearing, face covering, et cetera, for the general population, which wasn't applied initially. Some countries applied lockdowns very quickly. And we saw that in China and Asia. And in the UK, we resisted applying a lockdown. There was actually a paper that came out from Imperial looking at the possible mortality rate from the pandemic in mid-March. And that kind of panicked the government into moving to a more strict lockdown. And possibly because of that, we had higher incidences of mortality in the early stages. Temperature screening was widely used, probably largely ineffective. Travel bans were introduced early. Again, some countries like New Zealand locked down, and Australia locked down very early and very effectively and largely kept the virus out in the early stages. But there was a lot of discussion about how to do that. How to get the virus out in the early stages. WHO were actually lobbying to not apply travel bans. And that was part of the learning from the Ebola epidemics in West Africa, where the economic harm of the travel bans actually was worse than the harm from the infections themselves. As we all know, testing regimes were initially very limited. And it took time for tests to become widely available. We introduced lockdowns, work from home. And also, one thing that was very important was identifying and shielding the vulnerable in society. And again, that's something we possibly didn't do well enough in the early stages. Certainly in our residential elderly care homes, there were some big problems there. But I think those were themes that were seen globally. So in health and social care, in the first year of the pandemic up till December 2020, there were approximately just under 1,000 deaths in health and social care workers in the United Kingdom, which was out of proportion with the rest of the population. It was higher. And these were obviously younger people in the working age population. So they weren't the more vulnerable elderly. Also, the ethnic minorities were disproportionately represented in those workers. So health care workers, obviously, were still having to go to work and were still being exposed to the virus. Part of the reaction, and as occupational physicians, we're very familiar with this, was to default straight to PPE. And there were demands for increase in PPE. As we all know, PPE is only part of the answer. And we need to apply the hierarchy of controls. And this was not done well or consistently across society and across the NHS. And even when PPE was applied, often the PPE programs were poorly run. People didn't have the correct PPE. And they weren't being properly trained in how to use that. And I was speaking to Bob earlier this week. And he was saying there were instances where the patients would be sitting in the bed, wearing a respirator with an exhaust valve. And the health care practitioners would be wearing surgical masks. And it should have been the other way around. This is the result of a study carried out by the Health and Safety Executive in the United Kingdom. The Health and Safety Executive are our equivalent of OSHA. And they looked at 18 acute hospital trusts managing a biological hazard. Now, you would think that hospital trusts, biological hazards should be something that they would be very good at. That should be a core competence. And from that assessment, only five were fully compliant with their risk assessments. Four had advice given. And eight had improvement notices. So an improvement notice is given prior to prosecution to give people a chance to make corrections to any faults. So that was quite serious. And there were some very fundamental things that were missing. There was a lack of understanding of the risk assessment and hierarchy of controls. And the other thing that we found was that engineering controls, such as ventilation, were often neglected. Hospital ventilation systems often weren't well-maintained and weren't properly used. There was also a need to improve how risk was managed. PPE programs were poorly run. In the early stages, there was a lack of PPE. And the higher grades of PPE, the respirators, N95, N99, were reserved for what were thought to be the most at-risk staff, were people working in ITU for aerosol generating procedures. But in the same room as they were doing the aerosol generating procedures, you'd have ancillary staff working with surgical masks. Also, because of the problems with supply of PPE early on, the types of PPE changed frequently. And this caused big problems for face-fit testing, because every time a respirator type changed, that everyone needed to be face-fit tested for the new respirator. The other issue was the risk assessments weren't comprehensive either for the staff. We've already said that ancillary staff would be working in the same areas, clinical staff, but would have different levels of protection, although they had similar exposures. And another problem was that the clinical areas were well-managed, but areas outside that, often the break rooms, the offices, and the changing rooms, less well so. So one of the other things we found was if you looked at the whole of health and social care in the United Kingdom, there were three occupational hygienists working in that area for a population of around 2 million working people, which probably is not enough. A lot of the risk assessment work was done by safety professionals, and they probably needed some support. And also, the infection prevention and control departments also did the risk assessment work. But one of the problems that was found with them is they were focused on preventing infection for the patients, but not so focused on preventing infection for the workers. We need to make sure that when we're doing risk assessment, we're examining all the areas of exposure. We need to apply the basic principles and the hierarchy of controls. Also look at adopting best practice from other industries. Oil and gas, for instance, have got some excellent risk assessment programs, and those could be adopted and transferred over. Airline industries have very good procedures for incident investigation. And also, we need the flexibility to change our controls as we go along and we learn about the disease. And these are just some resources which are available on the SOM website. Thank you very much. We've reached a little pause. While we're waiting, rather than wasting the time, why don't we take a couple of questions? Hello. Thank you for that. That's really enlightening. The concern that we had, especially in infectious disease, was the high mortality in the younger population in the UK, which was different than what we were seeing in the US, which was mainly the elderly population. Was there, in retrospect, a reason why you were seeing such a higher mortality in the younger population, initially? I think there were, within health care workers, one of the theories, and I've got some colleagues who are working in NHS, and Shruti may be able to answer this more accurately than me. One of the theories was, within health care workers, that the younger workers were receiving much higher doses of virus. And that may have been one of the reasons why they were experiencing more severe disease. And it's also one of the reasons why they think that health care workers possibly might have higher incidences of long COVID, because they had bigger exposures. But Shruti's nodding, so I think I'll stop. So will you be talking about long COVID, your experience with long COVID at the UK? I'm not speaking about that in this session, no. So certainly, that's a controversial topic here in the US, how to address, manage, and deal with disability for those that have long COVID disease. Yes, I mean, I think it's a challenge in the United Kingdom as well. And we're looking to kind of how we can provide rehabilitation resources for those people with long COVID. And that's ongoing for us as well. We don't have the answers. Thank you. Just to comment on the previous speaker, the previous question, I sit on the Industrial Injuries Advisory Council for the British government, the Department of Work and Pensions. And we are actively considering long COVID. It is very controversial. And what I would say is we're thinking about it in the context of health and health care workers. And we're also thinking in the context of transportation workers, particularly those who have had passenger-facing roles, but incredibly complicated. If you think about passenger roles in transportation, the difference between, say, an Uber driver and some of the regulated taxi drivers, whether they had screens, whether they didn't, it's a very complicated piece, let alone being able to do any kind of assessment. But I also was just going to comment on the temperature screening. Only in as much as you touched on it, we did a paper that was published in JOEM. And a lot of companies did do temperature screening and then regretted it because it was very hard to stop. But we reviewed 15 million screenings in 14 companies, detected 700 cases of fever, 53 cases of COVID, and 2,000 cases were detected by means other than screening. So it really had no place, really, in terms of identification of cases. And once you've got the evidence base for that, we were able to sort of say, well, to vindicate the decisions not to do it. But it was very difficult because it was such a visible demonstration of care, even if it didn't work. A lot of people kept it up for that reason. I was working for Kimberley Clark through the pandemic, and we reached the same conclusion. And we weren't able to stop temperature screening, even though we knew it was ineffective. And that was largely as a result of what the unions and the workers wanted. Thanks for filling in there. We'll get a slight technical glitch, but we're good to go. And it's a great pleasure to introduce to Shweti Patani, who is the current president of SOM. And I'll let her. Thank you. Thank you, Richard. So good morning. Good morning, everybody. I'm Shweti Patani. I'm a consultant in occupational medicine, working in our National Health Service. And I'm the current president of the Society of Occupational Medicine. And it's a great pleasure to be here with you at the conference. I'm going to take a slightly different angle about what we've learned as a result of the pandemic and how it's actually impacted the growth of our occupational health services across our NHS. So our NHS is the largest employer in the world with 1.3 employees and approximately 70% female and 20% BAME. When the pandemic hit, we in occupational health certainly had been under-resourced and often seen as a back-office function and had been under-resourced for so long that actually when the pandemic hit, as Dr. Ponsonby said earlier, often many trusts didn't have the skills to do risk assessments or even advise their employers in a way that was most effective to support our health care workers and protect our health care workers. And part of this was recognized quite early on by our leaders in the NHS and so started the journey of actually growing occupational health and well-being together across our health service. In the interest of time, I won't focus too much on the detail that has led to our current five-year strategy. But what I will say is that we have been through a process of design and collaboration with our government and our health care and collaboration with our key stakeholders. So when it was recognized that actually occupational health is an important part of protecting our workers in whichever industry and actually it makes absolute good business sense, we launched our co-design growing occupational health and well-being strategy involving our national leaders, our chief medical officers, our HR directors in a process of consultation. What do you need from your occupational health and well-being services. What's missing? What's the vision? We also involved the people who use ROH services, including all the workers, and also our key people to grow ROH services, which is of course people who work in occupational health and well-being. As a part of the design, we also did quite a lot of work on gathering research evidence, best practice, and then a period of engagement. And last year, we launched our five-year strategy, and so we're now in the first year of a five-year strategy. The vision for that strategy has been to improve the health and well-being of our NHS people by growing our services and growing our people within those services to be trusted, strategic, and integrated partners. And at the bottom there are our key drivers, our four drivers, and looking at the strategic identity of occupational health, often seen as somewhere you're sent to when you're off sick. We want to be actually much more strategic, preventive, and then actually growing across systems. Across England, we are based in sectors, and we've got 42 what we call integrated care organizations overseeing delivery of care in that particular area. So we have a great opportunity to grow and develop our services across systems, growing our people, our occupational health people, and also impact evidence-based and practice. Excuse me. So these are some of the key actions that have taken place over the last year as a part of growing our occupational health services, and I'd just like to, in my final few minutes, share with you some of our achievements and where we want to be. We've actually developed quite a few of our current OH employees into being more senior leaders, identified management courses that they should do, and then actually empowered them and mentored them to develop their own services or move on to areas or other services where they can develop them. We are working closely with the Society of Occupational Medicine from the NHS and also the faculty in order to develop our nurses and our doctors. And in the last year, we've been able to actually get doctors and nurses and funded courses for them to be able to develop their skills in occupational medicine. Thank you, Hilary. So that's been a very key achievement. Another big area has been technology. The NHS has not always been good at keeping up to date with technology, so we've done quite a lot of work across systems with technology, and in particular, we are now actually using data to deliver occupational health services, and I think for us in the NHS, that's been a huge forward step to use data and to be able to convince our chief medical, no, rather, our CEOs to actually take account of the fact that workers are at the heart of being able to deliver healthcare. And the very last thing, I'm very happy to share these slides because there's quite a lot of information about the things that we have done and have been able to achieve, but the very last thing I would say is that in our NHS national operations guidance, for the first time ever, people and the workers are at the heart of the mission, and that for us has been a good achievement. So it's something that we have to deliver as opposed to we will deliver if there's time and capacity. I will stop there in the interest of time, but happy to take any questions. Thanks, Rita. Don't go away. If I could invite the panellists up. Very deliberately, that was a potpourri of COVID, and hopefully, we've come from very different directions and topics that you may not have seen touched on and addressed before, rather than the sort of traditional subjects. So a Forrest Gump runaround of a box of chocolates. I won't say who the strawberry cream or the coffee cream is. So I think we've met everyone, and the only one that hasn't been fully introduced is Professor Steve Nimmo, who is the present president of the Faculty of Occupational Medicine. So open up to the floor to any questions, please. My name is Shlomo Moshe. I'm from Israel. The question is about managing workers in the first year of COVID before vaccination. Now, we had to manage workers who claim they are not able to work in their job because it's too dangerous for them, and they have medical status, too severe to work with COVID patients. Now, in Israel, we wrote guidelines about this subject. Did you ever met this problem? Did you manage workers who refuse to work, especially teachers? We had many teachers who claimed they probably get infected from small children, young children that are not vaccinated and poor signs. Did you met this kind of problem? Within the UK, what the government introduced when they introduced the COVID laws, which was around the 24th of March, was we as occupational physicians were asked to identify vulnerable workers, and there was a kind of list of conditions and definitions for that. And those vulnerable workers had to have controls put in place, so they had to be removed from areas of infection. So for some people, that was quite easy because we also moved to home working. So for many professions, they moved to home working, and that included most educators. Most education moved to home working, supported from home. Within hospitals, obviously, that was more difficult, but again, and Shetty might want to talk more to this, but, you know, where vulnerable workers were identified, where possible, they were removed from the clinical environment, either to work in back offices or, again, working from home. Do you have anything to add? As was said earlier, in the UK, we very much take a risk-based approach, and certainly within the health, I think it's important to say there's recent published evidence that the majority of healthcare workers who became infected with COVID were infected in the community and were not infected in work, which I think is an important take-home point. But we had a kind of two-part risk assessment. We used something called COVID Age, which is basically looking at all the individual risk factors of the employees and then placing them in low, medium, high, and very high risk. But we also risk-assessed the areas in which COVID patients were being managed, and we used a traffic-like system of COVID Secure, where there was essentially no risk, and then green, yellow, and red. The OSHA guidelines. These are the OSHA guidelines with the colors. Yes. Yeah. So, what we did, basically, is we would do the COVID Age risk assessment of our individual workers, which would then determine which of those areas they could work in, whether it was completely COVID-free, green, yellow, or red. And that was how we approached it. But also, any worker who said that they didn't want to work in any kind of COVID environment at all was allowed not to do that from the point of view of, I mean, anxiety was considered to be a reasonable reason not to place people in that situation. Thank you. And actually, in the environments we worked in, there were some with higher risk that we absolutely said, you will not be able to work in those risks, because we can't get you in in time if something bad happens. So, they were all still paid and all that sort of thing. In the control room operators, you know, there were folks there where we'd say, you know, you have the option, if you feel uncomfortable, you know, to not, you know, to not work or to work from home. But so, some places, we gave them options if they wanted to still work, but there were some instances where we said, you can't. Like commercial divers, a lot of the remote workers and the offshore platforms and all. Thank you. Yeah, I think in the UK, the vulnerable workers, I think we'd all agree, it was actually something that we did manage quite well. I think it was yourself, and then it's rich after. I'll be brief. Good morning. I'm Tim Rumble. I am from the south, from Australia. And I'm an op physician. I was working for a utility during COVID. So, in central service, my wife was a doctor for an airline. So, in the spirit of the lessons learned, Australia obviously had a very different experience. It turns out it's remarkably effective to shut your border if you're an island. One of the things that's coming out now, however, is that there is an enormous morbidity that has come from the lockdown itself. And one of the early reports that has come out from the health authorities, it's a very big picture, said that lockdown should not be done again, ideally. I think what they mean is, should be done only for as long as they are absolutely necessary. They should be, if not, they should be the first thing lifted wherever possible. And I think we're seeing a big morbidity for the people most affected by the lockdown, which is now flowing through. Of course, that's not captured in any of the major data that came out early on. These are things that take some time to percolate through the system. Can you just expand on that? It's really interesting for us to hear that. What burden of disease are you, is it mental health, physical health? So, yes. So, all things really. The obvious burden is amongst particularly the kids for whom who were locked down, for them at that critical phase in life, partly school closures, but partly the lockdown itself. The cancer screenings that didn't take place, the normal GP visits that didn't take place, so the unofficial cancer screenings and wellness activities. And in fact, I think I have recently just seen that, interested to see what the Swedish data presented early on, that actually Sweden's excess mortality, despite the lockdown, was in fact right at the bottom, as in the best amongst Europe. Now that when they look from this distance. So, one of the interesting things I think that we're all starting to contemplate in Australia is when you get to a point when you can tally up the true costs, not just of COVID, but the public health response, that might be 10 years and that the true costs being what we've talked about, the deaths at the time and since the morbidity, the services that can't be done down the track because of the money spent at the time on supporting that. When you look at all of that, whenever that moment arrives, there's a bit of conjecture that the approaches that looked best at the start might in fact not look so good and the approaches that looked bad at the start might actually look okay. I can tell you just from what we see back home, you know, in the south, we've seen tons of folks that didn't get followed up on different conditions that have now done very poorly because they had no follow-up during COVID. My dad and I practiced together for 30-something years. I sent him home. He was in his 80s. I sent him home for a year and a half and I can tell you his physical condition declined rapidly from being home and not interacting with folks all day every day. My mom did fine because she had been at home, you know, but I think those of us at work and interact with people a lot, I think it did take a pretty good toll, really do. Just a couple of other points to add from the UK perspective. One of them is that National Health Service waiting lists have gone up dramatically. They've gone up to well over a million and now there are people waiting two or three years. So there are, and that undoubtedly has been associated with mortality and morbidity, but also people not being in the workforce. And on that point, there has been a huge increase in economic inactivity in the UK, a massive increase since 2019. It really has been very dramatic and it's one of the government's main priorities at the moment. And what appears to have happened is a lot of people in their 50s withdrew from the workforce during the pandemic and have never gone back again. And they've discovered they can live quite comfortably on what they earn. And that's having quite substantial economic effects at the moment. And we've just had our annual budget, our statement from the Chancellor of the Exchequer and a very large part of that was aimed at trying to address people who are economically inactive, some of it through occupational health. So there have been a number of unintended consequences, including increased morbidity and mortality because of increased waiting lists, but also that increase in economic inactivity. And as we all know, good work is good for you. Being out of work has a worse prognosis than some cancers. It has a worse prognosis and it's giving heart disease or chronic renal failure. So getting these people back into work is really important. Thanks Steve. And one final question and no one better than Rich Dawkins to give us our final question. Okay. Well, you already know my name. I'm Rich Dawkins. I'm an occupational medicine physician, mostly with experience in oil and gas. One of the things I noticed during the pandemic that was striking to me was the difference between the different industry sectors and how they approached it. Oil and gas did a really good job of risk assessment. Healthcare sector is what I really want to talk about. In the healthcare sector, we saw early on working conditions, work duration, people had to come to work sick because there was nobody else to fill their shift. As time went on, we saw that the effectiveness of personal protection became a real problem. Not just did they have it, but did it actually work? And then kind of, sort of in the middle when all the information around ivermectin and hydroxychloroquine came along, threats of violence against healthcare workers became a real issue. So those are the three issues I'd like to hear from the health sector standpoint, for those of you that are in it. Are people looking at this in a systematic way to try and deal with working conditions, deal with personal protective equipment effectiveness, and deal with threats of violence against healthcare workers? Thank you for raising that. Yeah, there has clearly, and we've got a real issue with filling vacancies in healthcare and lots of people having left the healthcare sector over the last couple of years. What we had issues with, and I think this investment in occupational health and wellbeing is an example, is actually we didn't really have the skillset almost, been de-skilled in doing risk assessments, advising on what should be happening out there. No real systems of getting adequate PPE or even fit testing was an issue to begin with. And then there were, we had incidences where people, unfortunately where healthcare workers were putting themselves in bin bags and actually going out to the press to say they didn't have adequate PPE. Violence in it, so there are lessons that are being learned is the bottom line. And we hope that we are preparing for any potential biological hazard or any other incident like that. And that there is work going on towards that. In terms of violence, yes, it's almost, during the pandemic itself, healthcare workers were seen very much and put on a pedestal and that's sort of fallen off really since we've gone into the endemic phase. And certainly now there's an increase in mental health among our healthcare staff, but among the population and also the long waiting lists, the frustrations that we have at the moment with people off long-term sick and the morbidity particularly of waiting on long waiting lists. You might have heard about strikes among healthcare workers, so junior doctors, nurses, et cetera, going on strike, which means that we are now further delaying operations. And I understand that over 100,000 appointments have been cancelled over the last couple of days whilst junior doctors were on strike for four continuous days straight after a bank holiday. So the rates of violence against healthcare workers from patients, but even among each other is rising. I hope that answers some of your question. Well, I think we'll draw that to a close. That is, we're virtually bang on time. So I hope you have enjoyed our post-COVID box of chocolates. You let us know which one you preferred, the strawberry or the caramel cream. So thank you for getting up early and joining us today. We're all around today, so please come free and ask us questions.

panel discussion

lessons learned

COVID-19 pandemic

United Kingdom

worker safety

personal protective equipment

lockdown measures

occupational health services

data-driven decision-making