Occupational healthcare
Employers have a legislated duty to arrange legislated occupational healthcare to all its employees regardless of the type and duration of the employment relationship.
If the employer so wishes, they can also expand their legislated occupational healthcare, offering the employees also medical care and other healthcare services. Offering tax-free health services requires that the free benefit is available at the same level to all employees and personnel groups.
The purpose of preventative occupational healthcare is
- prevent work-related illnesses and accidents
- promote healthy work and work environment
- promote the employees’ health and occupational and functional capacity at different stages of their career
- develop the functionality of the work environment.
Kela will compensate some of the healthcare costs of occupational healthcare services to employers. The realisation and costs of occupational healthcare services are reviewed annually through workplace co-operation. The employer and a staff representative will sign the Kela compensation application together.
The following information should be available at the workplace:
- service provider of occupational healthcare services
- the service location and contents of the occupational healthcare services
- the name of the occupational healthcare service’s doctor and nurse
- copy of the latest workplace review by the occupational healthcare services.
The obligation to arrange occupational healthcare services also applies to the employers of temp workers. The occupational healthcare service providers of the client company and the agency must work together to a sufficient degree, so that the current working conditions of the employee can be taken into consideration by the occupational healthcare services.
The employer and employees plan occupational healthcare together.
The planning and preparations for occupational healthcare is done through workplace co-operation between the employer and the employees. The employer must give the employee representatives all the information needed for processing the matter well in advance.
The occupational safety and health committee or – when one does not exist – the occupational safety and health representative help review:
- the general guidelines, contents and scope of the workplace’s occupational healthcare services
- the action plan of the occupational healthcare services
- implementation and impact assessment of the occupational healthcare services
- contents of the voluntary medical services and health services
- the employees’ suggestions for developing the operations, and
- the employer’s Kela application for the costs accrued due to arranging occupational healthcare services.
Planning the occupational healthcare services is based on cooperation in which also the providers of occupational healthcare services (doctor, nurse) take part. The employer must give the service provider all the necessary information that may affect the health of the employees. This includes information on types of working time, amount of overtime worked, age structure, types of employment contracts and all information related to performing the work.
The employer must also allow the occupational healthcare services to access the workplace during the working hours.
Some of the occupational healthcare services can also be arranged as remote services. However, the workplace visit related to the basic review and the targeted workplace review primarily takes place at the physical location.
The agreement with a service provider of occupational healthcare services must always be made in writing. If the employer also voluntarily pays for other medical services, it should be determined which medical procedures and examinations the employer will pay for in full or partially.
In addition to the individual employees, the measures of occupational healthcare services are targeted at the work, the working environment and the work community. The contents of occupational healthcare services are determined based on the needs of the workplace.
Legislated occupational healthcare services include services such as:
- workplace reviews
- planning the operations, action plan
- medical examinations, i.e. assessing the health state of the employees and their work and functional capacities
- activities maintaining and promoting work capacity
- advising and instructing the employees about the health hazards at the workplace
- monitoring the ability to cope with work
- supporting workers with deteriorated work capacity
- treatment referral of employees using intoxicants
- monitoring the health impact of the working conditions and the state of the working community (amount of occupational illnesses and work accidents)
- proposals to develop working conditions
- participation in arranging first aid
- aftercare in crisis situations (e.g. violent incidents, serious work accidents).
A workplace review is the basis for occupational healthcare.
The workplace review assesses:
- the chemical, biological and physical exposure in the role
- what personal protective equipment is needed
- the physical and psychosocial stress factors of the job, such as working positions, lifting work, time pressure and threat of violence
- the health state of the employees and their work and functional capacities
- the danger of illness caused by the employees’ individual characteristics
- the risk or threat of occupational illnesses, accidents and violence due to work
- change situations regarding the working conditions and the personnel
- the workplace’s opportunities for individual work arrangements based on work capacity
- work arrangements, such as working times, overtime and types of employment relationships
- risk of accidents and violence.
The workplace review is done in writing and must also be presented at the workplace. The health check-up plan will also be made based on the review.
When arranging the occupational healthcare services of a workplace, the special characteristics of the work of practical nurses and nurses have to be considered, including physically demanding work caused by moving and lifting patients and difficult work positions. The roles also have a great deal of psychosocial stress due to inadequate number of personnel, the time pressure, restless working environment, violence and the threat of violence. It is also important to consider the worktime arrangements that have health impacts, such as shift and night work and the necessary breaks and rest periods required by the work.
The workplace review and risk assessment processes should be carried out simultaneously or parallel to each other, so that the results from the risk assessment can be utilised for the workplace review and vice versa.
Health examinations are part of the preventative actions of occupational healthcare services that promote work capacity. They are used to assess an employee’s health and occupational and functional capacities. The objective of health examinations is to review the effect of health, safety and work capacity-related factors on the employee, and launch the preventative and corrective measures as early on as possible. Additionally, the objective is to promote the employee’s own resources and health to maintain their work capacity.
Health examinations are also done when assessing and supporting work capacity. The employer has the right and the duty to guide an employee to a health examination after observing that their occupational capacities have deteriorated. Before the health examination, the employer and the employee have to have a discussion on the employee’s work capacity in accordance with the early support model in place at the workplace. Goal-oriented health examinations are an important structure in the daily occupational healthcare cooperation to support and maintain careers.
Legislated health examinations are made in accordance with the action plan of occupational healthcare services, based on the exposures, risks, stress factors and special work characteristics determined in the workplace review and the risk assessment.
Attending a health examination prior to starting work is not mandatory. This examination is usually based on the recommendation of occupational healthcare services or the request of the employer in other positions than those causing a special risk of an illness.
If a health examination is done due to the work causing a special risk of an illness or due to health-related requirements of the work, a suitability statement is always given of these. If the health examination is voluntary and aims to assess and promote the employee’s health and work capacity, the occupational healthcare services will agree with the employer on whether statements are made regarding these health examinations.
These examinations do not assess the employee’s suitability to their job, but rather their current work abilities in relation to their work. The practices agreed on will be recorded in the action plan of occupational healthcare services.
An employee cannot refuse a health examination when it is done to review the employee’s work capacity. This is especially true in the case of a work causing a special risk of an illness.
For a justified reason, an employee can also request a health examination from the occupational healthcare services to review their personal stress levels and work capacities.
Other health examinations may include e.g. voluntary examinations performed by age group.
A health examination must be performed when, for example, an employee is working in a role causing a special risk of an illness or an accident. Other factors causing a risk of illness include the employee’s age, sex, physiological state, night work, threat of violence or introduction of new substances or work methods.
An employee’s initial health examination should be done prior to starting the work, but at the latest within one month of starting the work. Periodical health examinations must be repeated every one to three years.
Factors causing a special risk of an illness that are typical to workplaces of practical nurses include, for example:
- night work
- shift work
- threat of violence at work
- work in hot or cold premises
- chemical substances
- biological factors, such as various microbes, e.g. bacteria and fungi, yeasts and moulds
- physical factors, such as noise
- time pressure, insufficient resources.
The employer may only process personal data that is directly necessary for the employee’s employment relationship at the workplace. There are no exceptions to this even with the employee’s consent. The data must be primarily collected directly from the employee.
Health information is classified as sensitive data. These must be stored separate from all the other personal data collected by the employer. They must also name the persons or determine the duties that include processing health-related data.
Occupational healthcare services are only allowed to inform the employer on whether the employee is suited to the job, unsuitable to it, or suitable with certain limitations.
This clause on confidentiality can only be lifted in work causing a special risk of an illness, if the conclusions of the health examinations performed are related to occupational safety and health care. Similarly, the data can be disclosed both to authorities for supervising occupational safety and health and to other occupational healthcare service providers, if the employee starts working for another employer in a similar role causing a special risk of an illness.
Individual employees have the right to their own health data. Patient rights and the laws on data protection must be upheld in all actions of occupational healthcare services.