Employer profile: Transport for London focus on occupational health

Transport for London staff can find themselves subject to verbal and physical abuse from members of the public. Couteracting this forms part of a raft of occupational health initiatives, says Jamin Robertson

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Malfunctioning trains, broken down buses, signal failure, and unexplained delays are par for the course for users of London’s underground and bus network.

While these incidents may be frustrating for commuters, less understandable, however, are the actions of a minority of passengers who unleash their emotions, in the form of verbal or physical abuse, on the employees of Transport for London, the metropolitan travel operator. Robust occupational health policies and a supportive occupational health team, therefore, play an important role in helping staff to cope with the strain of this onslaught.

Dr Olivia Carlton, head of occupational health for TfL, explains that the abuse of staff is an ever-present problem. “It’s pretty prevalent. More and more, it’s about the verbal abuse, the drip, drip effect. When people are (subject) to continued abuse, that has an effect.”

With more than nine million journeys made daily on London’s buses, underground trains and Docklands Light Railway, TfL presents a busy and challenging working environment for employees, says Carlton.

“It’s a societal trend. People are so pressed for time, especially in London,” she explains.

As a result, the organisation places a high value on employee health and wellbeing, a position which is most visible to customers in the form of signs warning of TfL’s intention to push for the highest penalties for customers that abuse its staff. Each year, it also reviews organisational health and wellbeing resulting in a comprehensive health report.

Over the last two years, TfL has embarked on a particular drive to tackle stress and back pain, which have contributed to high absence levels among employees. A new health plan was introduced in 2004 to help curb the high costs which stem from these causes of absence. And to date, the approach seems to be working.

“We wanted to do it in a positive way. We wanted to encourage people to improve their health. The aim was to do something active in the area of back pain, stress, anxiety and depression. This would enable employees to do something for themselves, and support managers to handle these issues better,” says Carlton.

To help identify these underlying causes of poor health, TfL worked with rehabilitation and health consultants, EJT Associates. The consultancy firm also helped to re-focus TfL’s occupational health resources to be better equipped to tackle the issues.

“Out of that came some clear messages. Managers wanted more support on how to manage issues, and staff wanted more information. Managers on the Piccadilly line, for example, were worried about the effects of accident announcements on customers. They needed more support and advice,” says Carlton.

Having prioritised stress management, TfL introduced a stress reduction programme called Riding the Wave. It published brochures containing information on stress management, a stress survey, a relaxation CD, and information about the travel operator’s six-week stress reduction programme.

In addition, TfL reorganised its in-house counselling services, and counsellors were trained in cognitive behavioural therapy techniques.

Managers are now encouraged to enrol staff who have reported problems with stress to take part in weekly counselling sessions, which are held for two hours, one day a week over a six-week period. Employees are expected to attend every session.

“People talk about their feelings, learn about the stress cycle and why things get out of control. They identify how it happens to them, how to control it, and to take active control of their feelings. Depressed people tend to dismiss the positive. When you go through the list, sometimes there are a lot of negatives, but this looks at things in a balanced way by emphasising positive the (thinking) aspects as well. The group is hugely powerful in this situation. We also talk about lifestyle, nutrition and alcohol,” explains Carlton.

Since introducing the counselling programme, sickness absence rates among participating employees have continued to fall. Among the first intake of 56 employees, an initial measurement after three months showed that levels dropped by 79%. Despite a subsequent slight rise, sickness absence still dropped by 30% overall during the scheme’s first year. This resulted in reduced absence costs of £239,000.

Last year, about 150 employees took part in the stress reduction programme when it was extended to all 19,500 Transport for London staff after being initially limited to London Underground employees.

In some cases, however, group therapy may not be appropriate so the organisation also offers one-to-one staff counselling services.

Specific teams, meanwhile, are trained to deal with situations where a direct major response has been required, such as the terrorist bombings in central London in July last year. In this case, a dedicated unit was assigned to deal with subsequent trauma cases. “We had a real problem with absence after 7 July, although it’s now improving again,” says Carlton.

In conjunction with its stress reduction programme, TfL also modified its programme for the treatment of back pain, titled Back Fitness. This established specialist back exercise classes, held at TfL’s Department for Counselling and Trauma in Central London, alongside existing physiotherapy services to educate employees and demonstrate suitable exercises. Employees with back pain are encouraged to remain active with access to eight 90-minute sessions of therapy.

Staff also have access to a specially-designed brochure, which contains written and visual information, while a guide has been issued for managers.

“The (classes) teach people some of the underlying principles of pain. Attitudes and understanding can have an enormous contribution. They don’t have to be off sick to join in: if they’ve got back pain and are still at work then we’re interested. We want this to be a preventative approach,” says Carlton.

According to TfL, employees who are referred to the programme within six weeks of first going off sick return to work three weeks quicker, on average, than those referred after more than six weeks of absence.

London Underground has established a targeted referral rate of 80% for staff that have been absent for more than a week with back pain.

Employees have also noticed the difference. According to results of staff self-assessments of pain levels, the classes have had a significant impact. Some 48 employees, who were asked to score their level of pain on a scale between zero and 10, reported an average rating of eight at their first assessment. This dropped to six after some physiotherapy treatment and three following the back fitness class.

To target larger numbers of staff, the organisation holds 26 annual health fairs at a number of locations across its network. At each of these, employees can have their blood pressure checked, blood sugar levels analysed, and access information about their diet, physiotherapy and counselling services.

“We try and make it attractive to people. The feedback is fantastic. So far this year we’ve had 17 fairs and 816 people [in total] going through, so we’re hitting bigger numbers with the fairs. People even come in [to attend] on their day off.”

Carlton believes that the revised approach has the potential to reverse areas of poor health and high absence, not least due to the programme’s emphasis on personal responsibility.

“People have to make up the time they take to attend classes. We’re looking for them to take a more active engagement, and take more responsibility for their own health rather than just handing it to them on a plate. They are investing something, they’re more engaged, and we get a better outcome,” says Carlton.

TFL at a glance

Transport for London (TfL) was created in 2000 as the integrated body responsible for London’s public transport system. It is charged with implementing the Mayor of London’s transport strategy and managing the capital’s transport services.

TfL is responsible for London buses, the city’s Underground network, Dockland Light Railway and the management of Croydon Tramlink and London River Services. It also administers Victoria Coach Station and London’s Transport Museum. In addition, it runs the congestion charging scheme and regulates the city’s taxi and private car hire services. In 2004, it agreed a five-year £10bn investment with the government for transport infrastructure.

Career profile

Dr Olivia Carlton, head of occupational health for transport for London (TfL), joined London Transport (as it was then known) in 1988. A specialist in occupational medicine, she was promoted to head of the organisation’s medical service in 1994.

Transport for London (TfL) was established in 2000. Among Carlton’s achievments at the oragisation is the integration o fits counselling, and drug and alcohol units into a co-ordinated occupational health department. These had previously existed separately within a welfare department. In 2000, a physiotherapy service was also established.

Carlton’s career at TfL was interrupted between 1997-2001 when she was seconded to the Department of Health as an occupational health policy adviser. She returned full-time to TfL in 2001. A year later, Carlton was appointed Registrar for the Faculty of Occupational Medicine, a voluntary post within the national professional body, which she holds alongside her role at Tfl.