1. RSI issues in the UK today Stephen Fisher Chairman of Trustees RSI Action… ( the UK RSI charity) www.RSIaction.org.uk International RSI-Conference in Utrecht, 8 March 2008

2. UK RSI charities and support groups International RSI-Conference in Utrecht, 8 March 2008 Repetitive Strain Injury Association –founded by Ron Mullelly in 1986 –object: to support RSI sufferers –liquidated Mar 2004 (office and 7staff, funding problems) RSI support groups –London, Manchester, Bradford, (Nottingham, East Lancs, Edinburgh) Need for RSI national voice –pump priming funding from Hazards Campaign –initial contact autumn 2004 – new organisation agreed autumn 05. RSI Action –Companies House Registration: Feb 2006 –Charity Commission Registration: July 2006 –Objects: (1) to prevent RSI; (2) to support RSI sufferers

3. Types of RSI Type 1 RSI conditions are localised, and tests for these conditions exist. –Type 1 conditions (CTS, or tennis elbow) often result from one intense activity. Type 2 RSI conditions are diffuse, and are difficult to diagnose. –Type 2 conditions (often called Diffuse RSI) often result from computer and mouse work. Most RSI conditions can be prevented. Early treatment (within 3 months of first symptoms) is critical to full recovery. –Most conditions are not recognised for many months or years. –RSI is very difficult to treat. International RSI-Conference in Utrecht, 8 March 2008

4. Degrees of RSI Definitions by Suparna Damany author of “Its not Carpal Tunnel Syndrome” www.RSIrescue.com 1 st Degree RSI – Occasional unpredictable aching. Simple measures should result in full recovery. 2 nd Degree RSI – Frequent or predictable burning, throbbing etc. Further measures & treatment should result in full recovery. 3 rd Degree RSI – Constant pain, improper nerve sensations. Strength or endurance problems. Significant treatment, long partial recovery.

5. UK RSI issues RSI statistics UK H&S Legislation RSI prevention and management in the workplace UK Health System Benefits Government Policy –Benefit Fraud –Work is good for you –Health and wellbeing (DH + DWP) Personal injury cases International situation International RSI-Conference in Utrecht, 8 March 2008

6. HSE UK data - 1 2006/07 working days lost –30 mil days lost due to illness –10.7 mil days lost due to musculoskeletal disorders –3.5 mil days lost due to work-related upper limb or neck disorders 2006/07 incidence of illness –38% of all illnesses in the working population are musculoskeletal disorders (MSD’s) –18% of all illnesses in the working population are upper limb or neck disorders –34% increase in people affected by upper limb or neck disorders since previous year International RSI-Conference in Utrecht, 8 March 2008

7. HSE UK data - 2 2006/07 new cases of upper limb or neck work-related MSD –370 people per 100,000 workers –up 37% since previous year –up 23% since 2001/02 (rate was falling in intervening years) HSE Report RR561 (2007) –73% of DSE (display screen equipment) users reported 1 or more MSD symptom. –47% of DSE users had neck pain –39% of DSE users had shoulder pain –37% of DSE users had back pain –Prevalence of MSD symptoms in DSE users unchanged in 15 years International RSI-Conference in Utrecht, 8 March 2008

8. European Union data European Working Conditions Survey 2005 (published 2007) –61% of workers work at high speed –23% (54 million workers) muscular pain –44% of workers in tiring or painful positions –61% of workers have repetitive hand or arm movements –50% of workers use a computer for 25% or more of the day 55% by 2008 –32% of workers used computer for 75% or more of the day 38% by 2008 International RSI-Conference in Utrecht, 8 March 2008

10. UK Health and Safety Legislation Health and Safety at Work Act 1974 ‘Six-pack' regulations introduced in 1992 consisted of regulations on –Management of Health and Safety at Work Regulations 1999; –Workplace (Health, Safety and Welfare) Regulations 1992; –Health and Safety (Display Screen Equipment) Regulations 1992; –Manual Handling Operations Regulations 1992; –Provision and Use of Work Equipment Regulations 1998; –Personal Protective Equipment at Work Regulations 1992. In the first 4 years of the DSE Regulations –6 enforcement notices, no prosecutions In the first 4 years of the other 5 sixpack regulations –Over 1,000 enforcement notices, over 100 prosecutions 3 enforcement notices under DSE regulations since 1-1-2007 no prosecutions ever under DSE regulations And yet… 6 UK workers loose their job every day due to RSI! International RSI-Conference in Utrecht, 8 March 2008

11. European Union Inspection Campaign 2007 European campaign on manual handling of loads Transport industry –23 countries, 881 inspectors involved –2365 companies inspected –Intervention in 1916 companies (81% of companies inspected) Verbal and written warnings, administrative fines, cessation of work and legal prosecution Care industry –21 countries, 2217 inspectors involved –3042 companies inspected –Intervention in 2531 companies (83% of companies inspected) UK – MSD priority programme relies on guidance, rather than enforcement International RSI-Conference in Utrecht, 8 March 2008

12. RSI prevention & management in the workplace UK legislation in place since 1992 MSD prevention –few good employers minimise risks and provide physiotherapists –Some employers take no preventative action –Many employers do minimum, treat risk assessment as an unfortunate waste of time. –Lack of health and safety training, early RSI symptoms not identified The limitations and vulnerability of RSI sufferers is often not recognized in the workplace. Pressure for an early return to work. Red / Yellow / Blue / Black flags International RSI-Conference in Utrecht, 8 March 2008

13. Medical Early Retirement Depends on pension scheme rules Rules often require health condition and disability to be permanent Occupational health doctors usually deny that RSI is permanent International RSI-Conference in Utrecht, 8 March 2008

14. UK Health System No UK centre of excellence for RSI Little training for doctors on upper limb disorders Only a few consultants helpful in RSI conditions NHS physiotherapy – limited Private treatment – can be good, expensive UK health provision is influenced by the Medical Royal Colleges (MRCs) Diffuse RSI is not understood by MRCs International RSI-Conference in Utrecht, 8 March 2008

15. NHS plus ULD guidelines DH placed contract on Royal College of Physicians (RCP) to develop guidelines for the management of ULDs in the workplace. Quality conditions (SIGN 50) require patient representation RSI Action and RSI Support Groups have been excluded Royal Colleges have admitted they have no RSI expert! RSI Action campaigning for representation International RSI-Conference in Utrecht, 8 March 2008

16. Benefits Disability Living Allowance (DLA) –£17 per week, criteria - cannot prepare and cook fresh meal –not means tested Incapacity Benefit (IB) –physical or mental incapacity resulting in being unable to work –assessment doctors often do not recognize RSI –frequently need to go to appeal –new regulations will make it much more difficult to qualify –£61 per week initially, £81 per week after a year Industrial Injury (or disease) Disability Benefit (IIDB) –difficult for RSI to qualify –about £20 per week for RSI conditions International RSI-Conference in Utrecht, 8 March 2008

17. Government Policy Gordon Waddell & Kim Burton (from 2004) –Common Health Problems – includes ULDs –Read across from LBP to ULDs –Can not be prevented –Are not caused by work Work is good for you, early RTW 1 st National Director for Health and Work Benefit fraud Welfare Reform Bill 2007 Into work – off benefit International RSI-Conference in Utrecht, 8 March 2008

18. Personal injury cases No workers compensation system. Some illnesses & injuries are prescribed under IIDB, and benefit paid. Most rely on PI case in the courts. Often less that £50K, can be upto £200K Employers prefer to spend lots on defence than on prevention. International RSI-Conference in Utrecht, 8 March 2008

19. International Commission Occupational Health ICOH MSD Committee Chair – Professor Laura Punnett Premus is ICOH’s Prevention of musculoskeletal disorders conference, held once every three years. Premus 2007 – Boston USA –467 delegates from international scientific research –RSI was major topic, computer use was dominant problem –International researchers wanted to speak out, despite limited evidence –Lunchtime discussion with injured workers Premus 2010 – Angers (France) September 2010 –Opportunity for plenary or symposium by/for injured workers –What do we want from research scientists? International RSI-Conference in Utrecht, 8 March 2008

20. EU MSDs at Work Consultation 1 st phase consultation Nov 2004 to Jan 2005 2 nd phase consultation Oct to Dec 2005 Pressure for reducing regulation –Simplify and combine 90/269 and 90/270 –Rely upon non-regulatory guidance ETUC response 3 May 2007 (Roger Gauthy) –Provision for victims of MSDs –Concern for reduced regulation No representation of MSD victims International RSI-Conference in Utrecht, 8 March 2008

21. EU MSDs at Work Consultation Need for EU RSI groups to provide single voice in future EU regulation Commissioner Vladimir Spidla at EU MSD Summit in Bilbao, 26 Feb 2008 International RSI-Conference in Utrecht, 8 March 2008